Job description

Alberta Blue Cross® is an Alberta based organization dedicated to delivering exceptional customer experience and community leadership. We’re committed to providing the best health coverage to over 1.8 million members and take an active role in promoting wellness. We believe in what we do—and place trust in our employees to deliver our vision.

Working at Alberta Blue Cross® means having a career where you’ll be recognized for your contributions. We value diversity, encourage our team members to maintain a healthy work-life balance and provide opportunities for career growth.

OVERVIEW:

We are continuing to grow our Best Practices & Quality Control team and currently have an opening for a permanent full-time Best Practices Coordinator. With the guidance of the Team Manager, Best Practices & Quality Control, this position is responsible for analyzing claim adjudication results and reporting the findings, to ensure claims are paid in accordance to benefit plan rules. The Best Practices & Quality Control team identifies patterns, common errors and system issues to aid the department in reducing risk and improving effectiveness. This unit is also responsible for the department collection and subrogation processes.

WHAT YOU WILL DO:

Measures claims quality against established performance standards.
Perform additional quality assurance checks on claim adjudication results arising from departmental training sessions.
Investigate and update SIGMA (reporting system) and/or BlueExpress (adjudication system) as required.
Investigate and respond to subrogation requests from internal and external clients.
Handle collections and follow up as required.
Apply refund monies to applicable systems.
Cross-training opportunities within the Health Services department.
Make suggestions to improve workflow and processes.

WHAT YOU WILL HAVE:

Exceptional interpersonal skills with strong proficiency in verbal and written communication.
Demonstrated initiative, results orientation, and dedication to continuous improvement.
Strength in the areas of flexibility and innovation.
Excellent organizational and time management skills with the ability to complete multiple projects.
Analytical with good judgment in decision-making. Must have strong problem-solving abilities.
Intermediate to advanced knowledge of Microsoft Office products with particular proficiency in Word and Excel.
Self-directed with a strong sense of accountability.
Demonstrated ability to contribute within a team environment.
A comprehensive knowledge of Extended Health Benefits is an asset.

This position will remain open until a suitable position is select.

Alberta Blue Cross® is an inclusive employer committed to a workplace that reflects the diversity of the communities we serve. We empower and are advocates for our team members by welcoming, respecting and valuing their unique perspectives, backgrounds, and experiences.

We offer the opportunity to work in an innovative, high-energy team-focused environment. If you have the qualifications we are looking for, apply online at careers.ab.bluecross.ca

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