Director, Claims Audit – Investigation Services

Alberta Blue Cross

. Lead, coach and develop the Investigation Services and Claims Audit team .

Posted 9/24/2026full-timeCanadaLeadWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims audit, investigations, and fraud risk management, with a strong focus on compliance and program integrity. Proven ability to lead teams, develop strategies, and utilize data analytics to enhance investigative effectiveness.

Highest-signal resume keywords

Claims Audit LeadershipFraud Risk ManagementData Analytics UtilizationInterpersonal CommunicationRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigation PracticesEvidence HandlingProcedural FairnessPrivacy ManagementAnalytical JudgmentProblem-SolvingClaims ProcessesRisk ManagementPerformance MeasurementStrategy Development

Soft Skills

CoachingMentoringRelationship BuildingCollaborationCommunication

Tools & Technologies

Artificial IntelligenceData Analytics Tools

Certifications & Qualifications

CPACIACFE

Industry Keywords

InsuranceHealth BenefitsFinancial ServicesComplianceInternal Audit

About the role

Key responsibilities & impact

Lead, coach and develop the Investigation Services and Claims Audit team
Develop and execute a multi-year strategy for claims audit, investigations, fraud risk management, prevention and education
Oversee risk-based claims audit and investigation programs focused on member, provider and plan compliance
Build relationships with internal teams and external stakeholders, including providers, plan sponsors, regulators and law enforcement
Develop understanding of benefit programs, claims processes and controls, and recommend actions to reduce risk and strengthen program integrity
Advance the use of data analytics, artificial intelligence and other technology to identify emerging risks and improve investigative effectiveness
Establish performance measures and provide reporting and advice to senior leadership and Board committees
Continuously improve claims audit and investigation methods, operating practices and service delivery
Provide leadership in sensitive and complex matters while balancing fairness, customer experience, confidentiality and reporting
Champion prevention, awareness and education to strengthen compliance

Requirements

What you’ll need

Relevant professional designation or post-secondary education in accounting, finance, business, law, investigations or a related field
CPA, CIA, CFE or comparable accreditation preferred
Progressive leadership experience in claims audit, investigations, fraud risk management, compliance, internal audit or a related discipline
Experience leading complex investigations and audit programs in a regulated, insurance, health benefits or financial services environment is an asset
Strong knowledge of investigation practices, evidence handling, procedural fairness, privacy and confidential information management
Exceptional interpersonal, verbal and written communication skills, with the ability to present complex matters clearly to senior leaders and Board committees
Ability to identify opportunities, develop effective strategies and deliver measurable results
Success managing diverse, complex initiatives within established timelines and expectations
Strong analytical judgment and problem-solving skills
Experience using data to identify patterns, trends and risk
Experience developing talent through coaching, mentoring and performance leadership
Ability to build trusted relationships and collaborate across organizational boundaries
Satisfactory criminal record check required as a condition of employment following a conditional offer

Benefits

Comp & perks

Diversity-focused and inclusive workplace
Healthy work-life balance
Opportunities for career growth
Innovative, high-energy, team-focused work environment