Claims Fraud Investigator

About Pacific Blue Cross

Pacific Blue Cross (PBC) has been British Columbia's leading benefits provider for over 80 years. We are an independent, not-for-profit society with strong roots in BC’s health care system. We provide health, dental, life, disability, and travel coverage to 1 in 3 British Columbians through employee group plans and individual plans.

We are fueled by a commitment to keep health care sustainable for all British Columbians. Through our PBC Health Foundation, we fund projects that improve health outcomes directly related to mental health and wellbeing as well as the prevention and/or management of chronic disease. We are interested in finding people who want to make a difference and who are looking to grow their career with us.

We offer an attractive compensation and benefits package. Our workplace culture values health and wellness, diversity and equality, continuing education, environmental sustainability and giving back to the community.

• Flexible working hours of 7.5 hours per day, Monday to Friday (i.e., 37.5 hours per week).
• Paid vacation starts at 4 weeks per year, and increases with years of service.
• Hybrid work environment (i.e., a combination of work from office and work from home days).
• Generous benefits, including extended health, dental, and life insurance; depending on the plan that you choose, these benefit premiums can be 100% paid by PBC.
• PBC contributes the equivalent of 8% of your base salary to a Defined Contribution pension plan. No employee contribution or matching is required, giving you more take-home pay.
• Retiree Benefits plan that is available to employees who have at least 10 years of service with PBC and have reached the age of 55.
• Onsite gym, cafeteria, and access to virtual doctors/counsellors 24/7 via our Employee Family Assistance Program!

• We are searching for a permanent Claims Fraud Investigator to join our Fraud Investigations team.
• PBC’s compensation program is built on a pay-for-performance philosophy, rewarding both individual and organizational achievements. The typical hiring range for this position is $68,000 - $82,000 per year, with the starting salary determined based on a combination of skills, education, experience, and internal equity. As part of our total rewards package, you’ll be eligible for our annual bonus program.

Are you ready to take on a role that is responsible for investigating member and provider dental and extended health claims? If so, we want to hear from you! This is a unique opportunity to work on potential fraudulent claims and work on pursuing recovery of eligible funds to directly contribute to the health and well-being of our community.

This role is currently working hybrid from home and from our head office in Burnaby, BC. Apply this week if you would like to take on this role.

As a Claims Fraud Investigator, you will work on profiling member and provider dental and extended health claims and conducting comprehensive investigations of suspected claims fraud and insurance abuse including activity to pursue recovery of ineligible funds.

In this role, you would analyze and evaluate cases in order to develop investigative plans to execute.

You would gather information and evidentiary material to support findings that follows the evidence chain of custody procedures.

In this role, you would be preparing comprehensive reports that include evidence findings, results, and recommended recovery actions and amounts.

As a Claims Fraud Investigator, you would participate in preparation of file documentation for regulatory bodies and/or law enforcement.

• Bachelor’s degree in Criminology, Business, or an equivalent discipline.
• 3 – 5 years of related experience in fraud investigation or similar experience in reviewing, interpreting and analyzing extended health claims to identify potential areas of fraudulent or insurance abuse.
• Advanced Excel (complex data manipulation, statistical analysis, filtering and advanced use of formulas and functions).

It’s preferred and considered an asset if you have:

• Knowledge of the Health Professions Act.

If…