Claims Auditor conducting health audits and investigations at Alberta Blue Cross. Collaborating with providers for compliance and reporting findings in a hybrid work environment.
About the role
- Inside Special Investigator evaluating and investigating property claims for potential fraud. Collaborating with teams across Canada and utilizing investigative tools to uphold integrity.
Responsibilities
- Review and analyze claim information to identify indicators of potential fraud and determine the appropriate investigation approach and scope
- Conduct investigations by phone and through online and open-source research tools, as required
- Collect, secure, evaluate, and document evidence thoroughly and accurately
- Use loss control and internal tools to gather information from all available sources to support next steps, including recommending further investigation or closing non-suspicious files
- Provide clear, well-supported recommendations to settle or deny claims upon completion of the investigation
- Collaborate with Special Investigation teams across Canada and partner with internal stakeholders across business units to support investigations
- Contact Police departments, third parties and other external resources to pursue further information to assist investigations
- Provide backup support for Investigative Services administrative functions, as required
- Communicate claim denials to customers and brokers in a professional, clear, and compliant manner
- Accurately enter claim and investigation details into the case management system
- Support adjuster education by helping create and deliver training focused on red-flag identification and fraud awareness.
Requirements
- 2 to 3 years of property claims adjusting experience (minimum)
- Strong written and verbal communication, with effective presentation skills
- Curiosity, persistence, and strong research capability
- Sound judgment, critical thinking, and problem-solving skills
- Demonstrated ability to identify risk indicators and red flags in property claims
- Working knowledge of insurance trends, developments, and current regulations
- Ability to work under pressure, manage multiple stakeholders, and meet tight deadlines
- Strong proficiency with standard desktop and online tools
- A collaborative, solution-oriented mindset and strong teamwork skills
- High attention to detail, particularly in data entry and technical documentation
- Coaching and training experience is an asset.
Benefits
- Flexible work arrangements and a hybrid work model
- Possibility to purchase up to 5 extra days off per year
- Multiple benefits offered to support physical and mental wellbeing, including telemedicine, Wellness account and much more
- Share plan & other savings: up to 12% of salary or even more
- Pension offerings provide flexibility and long-term security
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