CLHIAis the respected voice of Canada's Life and Health insurers . We work alongside our members to advance public policy solutions that ensure a sound and vibrant life and health insurance industry that allows Canadians to enjoy greater financial security and access to valuable supplementary health benefits. This position is currently a hybrid position where you are expected to attend one of our offices (Toronto, Ottawa, Montreal) at least 2 days a week.

Exceptions may be considered for highly qualified candidates residing outside these areas. Flexible - this is a position where you will have to approach an issue through different angles and the ability to analyze a situation or problem. We are currently recruiting for a Health Claims Investigative Administrator.

This role will report to the Director, Anti-Fraud Programs and is responsible for the effective administration and coordination of the industry's joint investigation program. Please note, you will not be investigating claims in this role. This role supports the end-to-end management of investigation activities by maintaining accurate records and data systems, coordinating documentation and communications, preparing reports and meeting materials, and ensuring the integrity, accessibility, and continuous improvement of program processes and information.

The incumbent collaborates with internal and external stakeholders to support program operations, reporting requirements, and strategic objectives through strong organizational skills, attention to detail, sound judgment, and a commitment to confidentiality and data accuracy. Employer-paid health, dental, extended health,



and paramedical advantages (including virtual services) A defined contribution pension plan with employer matching Prepare and format documents for posting on the CLHIA's website or microsites, and coordinate receipt of materials and database entries. Respond to internal and external inquiries professionally and prepare materials for meetings and case referrals.

Manage tasks required to maintain and advance the program, such as updating reference materials, contract and meeting coordination. Ensure timely and accurate data entry into reporting systems, maintaining data integrity for reporting and trend analysis purposes. Complete analysis and reporting as required.

University degree in a related field with 3+ years of experience, including working with fraud investigators, and operational functions. Knowledge of the life and health insurance industry, and/or claims processing experience. Previous fraud investigation experience is a requirement.

Knowledge of anti-fraud technologies and other management tools. Strong background in operations in the life and health insurance industry - group benefits an asset.

Skills in data management and analytics are an asset Advanced knowledge of MS Office and database applications. Some knowledge of Power BI and/or SQL are an asset Bilingual (English/French) or ability to read and speak some French is an asset. The CLHIA does not use artificial intelligence to screen, assess, or select applicants.

On request, we provide accommodation for applicants with disabilities in accordance with the requirements of theAccessibility for Ontarians with Disabilities Act, 2005and Quebec’s disability rights legislation.

📌 Health Claims Investigative Administrator (Toronto)
🏢 Canadian Life and Health Insurance Association
📍 Toronto