Audit Investigator

Description:

Medavie, a national health solutions partner with over 8,000 professionals, is seeking an Audit Investigator to join its Government Audit unit. Medavie is a not-for-profit organization dedicated to improving the wellbeing of Canadians through innovative solutions in insurance, healthcare, and emergency medical services. The Audit Investigator will play a critical role in identifying abnormal claiming patterns among healthcare providers and ensuring the integrity of drug, hospital, extended-health, and dental benefit programs.

This role is ideal for a self-directed, analytical, and detail-oriented professional who thrives in investigative work, enjoys problem-solving, and has strong communication skills. The Audit Investigator will plan and perform audits, analyze claims data, and prepare reports that may be used by management, law enforcement agencies, or regulatory bodies.

Key Responsibilities include:

• Planning, performing, and leading claims audits and investigations in alignment with industry best practices.

• Using query analytics and software tools to detect inappropriate claims submissions by healthcare providers.

• Conducting provider and plan member audits, including pre-audit and post-audit work, analyzing findings, and preparing final reports.

• Summarizing findings, recommendations, and corrective actions in comprehensive written reports.

• Building and maintaining strong working relationships with colleagues, service providers, and customers to support problem-solving, continuous improvement, and risk mitigation.

• Demonstrating a commitment to professional growth, staying current with audit best practices, and developing industry knowledge.

• Leading or assisting with other risk-based projects as assigned.

Qualifications:

• 1–3+ years of experience in auditing, investigations, or fraud detection, ideally within insurance or healthcare.

• Relevant post-secondary education required; professional designations such as CPA, CIA, CFE, or equivalent are strong assets.

• Experience with data analytics tools (e.g., ACL, Excel) and the ability to apply statistical methods to large datasets.

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

• Excellent communication skills—both written and verbal—with the ability to present findings clearly.

• Proven ability to manage multiple priorities and meet tight deadlines.

• Solid computer skills, including spreadsheets, word processing, and flowcharting.

• Professional or educational background in healthcare fields (e.g., nursing, dental, vision care) is an asset.

• Financial services or insurance industry experience preferred.

• Valid driver’s license and willingness to travel occasionally, including out-of-province travel.

• Bilingualism (English/French) is an asset.

• Must meet federal Reliability Status Clearance (Enhanced Level B) requirements, including fingerprinting, criminal record check, credit check, and proof of Canadian residency for at least 5 years (Permanent Resident or Citizen).

Working Conditions and Benefits:
This is a remote role with occasional travel required. Medavie offers a supportive, flexible, and inclusive workplace culture with competitive compensation, comprehensive health and dental benefits, opportunities for career growth, and employee wellness resources.