Job Description

Position Type:
Permanent

If you're looking for a fulfilling career that can make a real difference in your life, and the lives of others, you've come to the right place.

As a national health solutions partner, we put people first in everything we do - and that begins with our team of 8,000+ professionals who bring a cross-section of diverse life experiences and career expertise to Medavie. By collaborating and innovating together, our employees are creating industry-leading solutions in insurance, primary care and emergency medical services that impact millions of lives in Canada each year.

Our mission is to improve the wellbeing of Canadians so that every life can be lived to the fullest - and it's reflected in our award-winning culture. We celebrate individuality and value the diverse perspectives and skills our employees contribute. We go beyond providing competitive pay and comprehensive benefits to offer opportunities for personal and professional growth, flexible work options, meaningful experiences, and supportive leadership. Medavie is where employees can be their best selves, feel they belong, and achieve their full potential. Be part of it by applying for a position with us today.

The Opportunity

We currently have an opening for an accountable, self-directed individual to join the Government Audit unit as Audit Investigator. As a member of the team, your accountabilities will include applying audit and analytical tools and techniques in the review for abnormal claiming patterns among healthcare providers of our company's drug, hospital, extended-health and dental benefit programs. You will be required to maintain constant and efficient communication with service providers and customers.

Key Responsibilities

• Planning, performing, and leading claims audits and other investigative engagements in a manner consistent with audit and fraud examination industry best-practices;
• Applying query analytics and expert software to profile for indicators of inappropriate claims submissions by healthcare providers;
• Performing audits of providers and plan members including: pre-audit and post-audit work; determining the most appropriate course of action based on your findings; compiling findings; and completing final case reports in a manner that is presentable to management, law enforcement agencies and/or other regulatory bodies as required;
• Summarizing findings, recommendations, and corrective actions in written reports;
• Building, developing and maintaining strong relationships with colleagues and customers, to encourage open dialogue and collaborative commitment to problem solving, continuous improvement, and corporate risk mitigation;
• Maintaining a commitment to ongoing learning, developing audit skills in line with best-practice, and building a strong foundation in insurance and healthcare industry principles and knowledge; and
• Leading and assisting in the performance of other unique risk-based projects.

Qualifications

• Knowledge of audit principles, practices and methodologies acquired preferably through 1-3+ years of experience in auditing and/or investigative practices;
• Relevant post-secondary education is required. A professional designation in fraud detection, auditing or investigative techniques (e.g. CPA, CA, CMA, CGA, CIA, CFE, etc.) or professional experience in a healthcare field would be considered an asset;
• Experience in the use of data analytics software (e.g. ACL, Excel, etc.), along with an ability to learn and apply statistical inference and data sampling principles to large data populations;
• Excellent initiative, problem solving and analytical skills;
• Ability to work well with a team and collaborate both internally and with external stakeholders and management;
• Ability to articulate thoughts in a clear and concise manner (both verbal and written);
• Ability to manage multiple competing priorities and tight deadlines;
• Demonstrated computer skills (including word processing, spreadsheets, flowcharts, etc.);
• Financial Services experience would be an asset, preferably within the insurance and/or healthcare industry;
• Professional experience in a healthcare field will also be considered (Nursing Assistants, Dental assistants, Vision Care, etc.);
• Occasional travel required. Must be available to work out of province as required;
• A valid driver's license is required;
• Bilingualism (English and French) is considered an asset;
• Security Clearance Requirement: In conjunction with our contract with the Federal Government, you will be required to have Reliability Status Clearance (Enhanced Level B) prior to your start date . This includes Fingerprinting, Criminal Record Check, Credit Check and you must have resided in Canada for at least 5 years and hold Permanent Resident or Citizenship Status.

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We believe our employees should reflect the communities we serve and welcome applications from candidates of all backgrounds. To provide the best experience possible, we will support you with accommodations or adjustments at any stage of the recruitment process. Simply inform our Recruitment team of your needs. We are committed to making sure recruitment, retention, advancement, and compensation are fair and accessible while following all relevant human rights and privacy laws . We appreciate everyone who has shown interest in this position. Only those selected for an interview will be contacted.

If you experience any technical issues throughout the application process, please email: [email protected] .

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