Senior Claims Review Specialist

We are looking for a Senior Claims Review Specialist

Reporting to the Operations Manager, Audit and Claim Verification the Senior Claims Review Specialist is a key member of the Audit and Claim Verification team responsible for completing claim audit processes for a key Canada Life client. The main function of a Senior Claims Review Specialist is to conduct claims reviews of providers and members. The Senior Claims Review Specialist will also handle escalations within the team as well as with other units within Canada Life.

What You Will Do

• Plan and document the results of multi claim audits according to department procedures
• Conduct claims reviews, including risk-based selection of claims, assessment of documentation and on-site completion of reviews
• Write client-facing and provider facing reports regarding audit findings, including coordinating with and referrals to the investigations team.
• Identify fraud risk factors of claims reviewed and escalate or refer for further investigation if appropriate
• Handle escalations from within the team as well as from other business units, to investigate concerns identified

What You Will Bring

• Excellent communication skills, both written and oral
• Strong continuous improvement focus
• Ability to work independently and collaboratively
• Strong technical skills
• Bilingual(English/French) is an asset
• Post-secondary degree/diploma or equivalent work experience
• Understanding of Health Claims processes and business knowledge would be an asset.
• Some travel will be required for this role
• Experience within a paramedical or other clinic setting considered an asset
• Ability to manage multiple demands with tight deadlines is necessary.
• Enhanced Security Screening is a requirement of this position.
• Minimum 2 years related work experience in audit/quality/fraud/clinic setting

Be your best at Canada Life- Apply today!

Being a part of Canada Life means you have a voice. This is a place where your unique background, perspectives and talents are valued, and shape our future success.

You can be your best here. You’re part of a diverse and inclusive workplace where your career and well-being are championed. You’ll have the opportunity to excel in your way, finding new and better ways to deliver exceptional customer and advisor experiences.

Together, as part of a great team, you’ll deliver on our shared purpose to improve the well-being of Canadians. It’s our driving force. Become part of a strong and successful company that’s trusted by millions of Canadians to do the right thing.

Canada Life serves the financial security needs of more than 13 million people across Canada, with additional operations in Europe and the United States. As members of the Power Financial Corporation group of companies, we’re one of Canada’s leading insurers with interests in life insurance, health insurance, investment and retirement savings. We offer a broad portfolio of financial and benefit plan solutions for individuals, families, businesses and organizations.

We are committed to providing an inclusive, accessible environment, where all employees and customers feel valued, respected and supported. We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employee  has the opportunity to  reach their potential.

Canada Life would like to thank all applicants, however only those who qualify for an interview will be contacted .