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Senior Analyst, Health & Dental Management

Req. #:  14406
Department: Health & Dental Fraud/Life
Location: Montreal, QC CA
Job Status: Permanent Full-time
Grade:  06
Category: Group Insurance - Health & Wellness
Description:

This national role is responsible for supporting the Sr Team leader and the Senior Consultant, Health and Dental Management. Will provide internal and at times external support to ensure consistent quality delivery of services, assistance with technical and procedural matters based on Standard Life business requirements and objectives. Will also be backup for the Specialist, out-of-province/country claims management.

  • Assist the Sr Team Leader and Senior Consultant in the revision and analysis of various management reports from third party sources (Telus, AXA, TPP), quickly taking action on any identified discrepancies. This will include documenting findings, agreement on action plans from various parties, with follow-ups to ensure completion.
  • Become expert resource and liaison for Line of Business colleagues as it relates to various claims matters or system capability.
  • Participate in the preparation, review, analysis and documentation of outside audits, performed by the Senior Consultant and or the Business Unit Audit Specialist, of outsourced provider claims activities, as well as third party payers. Will also help in monitoring the progress of recommendations, providing feedback on action plans and target dates when necessary.
  • Participate in the adoption of best practices by keeping abreast of the trends and innovations via internal and external benchmarking, networking, attending industry seminars, reading trade journals, etc. Coordinate with the Senior Consultant activities required to implement new practices, if any.
  • Participate in research & recommendations for changes in best practices and contractual allowances.
  • Maintain knowledge of the Telus claims system, in order to provide feedback on required system changes to better support required control features, new benefit offerings and/or Call Centre needs.
  • Establish relationships with providers and third party payers for daily issues i.e. quality, service, client issues, procedures, etc.
  • Maintain knowledge of out of province/country claims and reimbursement policies and procedures to act as a backup for the out of country specialist.
  • Identify, implement and maintain controls to mitigate financial and operational risks.
  • Ensure compliance with regulatory requirements and internal policies.

REQUIREMENTS

  • College diploma in Business Administration, Accounting or Health or related studies.
  • Five years experience in group insurance or equivalent experience.
  • Good knowledge in Group Life and Health products, primarily dental, medical and pharmacology knowledge.
  • Complementary course such as HIAA, LOMA, ICA or CEBS, an asset.
  • Bilingual (with good communication and written skills in both French and English).
  • Knowledge of control and audit concepts an asset.
  • Excellent knowledge of policies, practices and procedures including CLHIA guidelines and the regulatory authority.
  • Knowledge of provider systems (Telus, Medirect, AXA, etc.) is an asset.

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The personal information gathered on this website is considered strictly confidential and will be used exclusively for recruitment purposes by the Human Resources department at The Standard Life Assurance Company of Canada. Under no circumstances will this information be used for other purposes or forwarded to a third party without the candidate’s authorization.





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