Compliance Analyst (Pharmacy) - Claims Audit and Investigation Services

Details

Location Name
Alberta Blue Cross - Edmonton
Edmonton, Alberta, CA
Date Posted Oct 02, 2019
Profession Pharmacy
Career Level(s) Entry Level
Job Type(s) Permanent, Full Time
Education Level(s) Not Specified
Job ID job-9648

Position Summary

FUNCTION:

Claims Audit and Investigation Services conducts audits of health care providers and plan members to assure compliance with provider agreements, group contracts, policies, procedures, applicable legislation, and Alberta Blue Cross controls.  This position offers the opportunity to work with a team dedicated to accuracy and detail.

The main responsibility of this position is to complete audits, analyze and report on claims submitted by Pharmacies. 

DUTIES AND RESPONSIBILITIES:

  • Complete on-site visits and special projects to collect information and documentation.
  • Complete claims analysis to assure compliance with provider agreements, group contracts, policies, procedures, applicable legislation, and Alberta Blue Cross controls.
  • Prepare working papers, letters and reports.
  • Develop and maintain good relationships with service providers and internal partners.
  • Follow the team’s policies, procedures, and quality standards.
  • Under the guidance of the Team Manager, issue reports on claims and /or monetary adjustments and changes in practice to facilitate compliance.
  • Participate in internal department process reviews and make recommendations for process improvements.
  • Field work to collect documentation is a key aspect of this role. Travel is required within Alberta.
  • A valid Class 5 Driver's License is required.

SKILLS AND KNOWLEDGE:

  • In the process of completing or have completed a post-secondary degree preferably in science or business.  Related experience may also be considered.
  • Demonstrate strong analytical, investigative, and logical thinking skills with the ability to solve complex problems.
  • Excellent interpersonal and communication skills, including investigation interviewing skills
  • Proven track record of being organized, committed to accuracy, and detailed.
  • Exhibit commitment to teamwork and be willing to learn and adapt to changing priorities.
  • Capacity to work on multiple projects, prioritizes, and meets deadlines.
  • Demonstrate self-direction with a strong sense of responsibility and accountability.
  • Proficient in Microsoft Word and Excel. 
  • Experience in the health care benefits industry, Pharmacy industry, and audit is desirable.

Alberta Blue Cross offers a competitive salary and benefits package and the opportunity to work in a challenging team-oriented environment.  This position will remain open until a suitable candidate is selected.  If you have the qualifications we are looking for, please submit your resume and salary expectations to www.ab.bluecross.ca.


< < Back