Job Description

Permanent Full Time-Role descriptionWe are looking for a Senior Claims Review SpecialistReporting 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

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

What you will bring

• Post-secondary degree/diploma or equivalent work experience
• Minimum 2 years related work experience in audit/quality/fraud/clinic setting
• Experience within a paramedical or other clinic setting considered an asset
• Excellent communication skills, both written and oral
• Ability to manage multiple demands with tight deadlines is necessary.
• Strong technical skills
• Strong continuous improvement focus
• Ability to work independently and collaboratively
• Understanding of Health Claims processes and business knowledge would be an asset.
• Some travel will be required for this role
• Bilingual is required
• Enhanced Security Screening is a requirement of this position. Reliability Status security clearance - this is a personnel security status that is required before an employee can gain access to Protected B information, assets or work sites as outlined by the

website. * Be the first point of escalation for complex claims, customer issues-The base salary for this position is between $43,800 minimum - $65,700 maximum annually. This represents base salary only and does not represent other variable compensation components of our total compensation ( i.e. annual bonus, commission etc). If you are selected to move forward in our recruitment process, your recruiter will be able to discuss additional details of our total rewards program with you.Career opportunities will be open a minimum of 5 business days from the date of posting, closing dates will vary depending on the search activity. All applications received will be reviewed on a rolling basis.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.It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Canada Life policies. To request a reasonable accommodation in the application process, contact talentacquisitioncanada@canadalife.com.Canada Life would like to thank all applicants, however only those who qualify for an interview will be contacted.#LI-Hybrid#IND!!Requisition ID: 818Category: Customer Service and AdministrationLocation:Winnipeg, MBDate: Apr 8, 2024If you are not finding suitable opportunities now, please click below to join our talent community!

Canada Life