The objective of this role is to mitigate financial risks associated with inconsistent administrative practices and suspicious claims, while having a positive impact on the customer experience and our image. The lead auditor performs audits for Health and Dental claims by validating the requests submitted by the providers to ensure their compliance according to the conditions set out in the agreement and the best practices. The lead auditor is also responsible for ensuring team productivity, team engagement, act as a mentor to other team members and are accountable for meeting service levels and deliverables for our customers.
•Perform provider audits (Health and Dental) according to clients' contractual agreements
•Maintain documentation related to audits (reports, conversations and exchanges)
•Analyze potential fraud cases in order to protect the financial interests of our clients, this may involve contacting the providers, professional associations, customers, policyholders, judicial authorities and insurance companies
•Responsible for monitoring recoveries related to audits and invoicing with our customers
•Perform profiling analysis and system data analysis
•Responsible for achieving the team's goals and meeting service level commitments
•Provide instructions to the claims team to make adjustments and/or reversals of transactions as needed
•Provide support to our insurers and other customer service teams (Carrier Support)
•Prepare customer reports on results and trends
•Responsible for training and coaching team members
•Promote a continuous improvement environment, identify and recommend changes to improve the effectiveness of audit processes
•Participate in client meetings and special projects
•Participate in industry meetings, keep abreast of new developments Qualifications:Knowledge, Skills and Skills:
•Ability to handle confidential information and protect privacy
•Ability to work under minimal supervision
•Ability to work independently or in a group setting
•Excellent organizational skills
•Excellent problem solving ability
•Strong analytical skills and investigation
•Ability to perform well under pressure and have good time management and priorities
•Excellent decision-making skills
•Customer centric and builds good internal and external relationships
•Demonstrates good leadership and coaching skills
•Strong dental knowledge, complementary health care and/or audit practices
•Good knowledge of the claims process an asset
•Practical knowledge: Education Experience:
•Knowledge of Microsoft Office suite
•Training directly related to health care or dentistry
•Completed post-secondary studies/certification
•Minimum of 5 years of equivalent experience (combination of work in a related field and audit experience)
•Training related to dental or health care Who is TELUS?
We're a high-performing team of individuals who collectively make TELUS one of the leading telecommunications companies in Canada. Our competitive consumer offerings include wireline, wireless, internet and Optik TV™. We also deliver a compelling range of products and services for small, medium and large businesses; and have carved out a leadership position in the health, energy, finance and public sector markets with innovative industry specific solutions.
TELUS Health is an IT leader in Canada that focuses on the health sector. Our mission is to improve the way information is being used along the continuum of care to better the health of citizens in Canada and in selected countries.
Everyone belongs at TELUS. It doesn't matter who you are, what you do or how you do it, at TELUS, your unique contribution and talents will be valued and respected. Because the more diverse perspectives we have the more likely we are to crack the code on what our customers want and our communities need.
Do you share our passion?
At TELUS, you
create future friendly® possibilities.
At TELUS, we are committed to diversity and equitable access to employment opportunities based on ability.Disclaimer:
In accordance with the TELUS Health Solutions Data Center Security Policy, as a condition of employment, all personnel whose job functions require they work at a Data Center and/or have access to detailed knowledge of technology related to client service delivery, are subject to a Personnel Security Screening conducted through the
Government of Canada.