Audit Investigator

Description:

Medavie is seeking a dedicated and self-directed Audit Investigator to join their Government Audit unit. The role focuses on reviewing abnormal claiming patterns among healthcare providers within the company’s drug, hospital, extended-health, and dental benefit programs. The position is fully remote and involves collaboration with service providers, customers, and internal stakeholders to ensure compliance and mitigate risks.

Key Responsibilities:

• Plan, perform, and lead claims audits and investigative engagements following audit and fraud examination best practices.

• Apply query analytics and software tools to detect indicators of inappropriate claims submissions.

• Conduct audits of providers and plan members, including pre-audit and post-audit work, determining appropriate actions, and compiling findings into final reports for management, law enforcement, or regulatory bodies.

• Summarize findings, recommendations, and corrective actions in clear, professional written reports.

• Build and maintain strong relationships with colleagues, customers, and stakeholders to foster collaboration and problem-solving.

• Continuously develop audit and investigative skills, and maintain knowledge of insurance and healthcare industry principles.

• Lead or assist in unique risk-based projects as required.

Qualifications:

• Post-secondary education required; professional designations in fraud detection, auditing, or investigative techniques (CPA, CA, CMA, CIA, CFE, etc.) are assets.

• 1-3+ years of experience in auditing or investigative practices.

• Experience with data analytics software (e.g., ACL, Excel) and applying statistical inference to large data sets.

• Strong initiative, analytical, and problem-solving skills.

• Ability to work effectively in teams and with external stakeholders.

• Excellent verbal and written communication skills.

• Ability to manage multiple priorities and meet tight deadlines.

• Experience in financial services, insurance, or healthcare is an asset.

• Occasional travel; must work out of province as required.

• Valid driver’s license required.

• Bilingualism (English/French) is an asset.

• Security Clearance Requirement: Reliability Status Clearance (Enhanced Level B), including fingerprinting, criminal and credit checks, and Canadian residency of at least 5 years (Permanent Resident or Citizen).