Manager, Analytics, Recoveries & Reporting – Claims Audit & Investigation Services

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 employees to maintain a healthy work-life balance and provide opportunities for career growth.

OVERVIEW:

We are seeking a highly motivated and experienced Manger of Analytics, Recoveries & Reporting to join our dynamic team. As the Manager of Analytics, you will leverage your expertise is advanced analytics, artificial intelligence to provide innovative and data driven solutions to complex business problems. You will be responsible for enhancing the efficiency and effectiveness of the analytics function and build a team of high performing data scientists and analysts. In addition, you will oversee processes related to recoveries and reporting. Reporting to the VP and Chief Audit Executive, the Manager will work closely with key stakeholders, the primary and secondary users of the analytics to ensure insights are provided on claims data and operations.

WHAT YOU WILL DO:

• Set department priorities to utilize predictive, prescriptive, and cognitive analysis in departmental assurance and compliance functions.
• Design and build continuous risk monitoring and predictive analytics tools to enhance department compliance, risk management, and assurance functions.
• Oversee the national repository for claims alerts.
• Develop and maintain department risk dashboards.
• Communicate insights and risks with key stakeholders, auditors, and senior management.
• Oversee the whistleblower hotline intake process.
• Oversee the preliminary investigation team.
• Develop and maintain reporting to key stakeholders.
• Oversee the recoveries identified and develop reporting to key stakeholders.
• Proactively participates in internal and external cross-functional teams and builds effective working relationships to support a collaborative environment.

WHAT YOU WILL HAVE:

• Master’s degree or Doctorate in Mathematics, Physics, Business, Finance, Economics, Statistics, or Computer Science. A related designation of CA, CIA, CFE or equivalent would be an asset.
• 10 years’ experience in advanced analytics.
• 5 years plus experience with leadership.
• Knowledge of health benefits industry an asset.
• Experience with AI and ML.
• Knowledge of data model development.
• Understanding of regulatory and privacy requirements in data science and AI.
• Expert knowledge of SAS, R, Python, ACL, IDEA, GitLab.
• Excellent communication and critical thinking.
• Ability to thrive in fast paced environment.

This position will remain open until February 28, 2025.

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 employees by welcoming, respecting and valuing their unique perspectives, backgrounds, and experiences.

We offer a competitive salary and benefits package and the opportunity to work in an innovative, high-energy team-focused environment. If you have the qualifications we are looking for, please apply.