Alberta Blue Cross® is an Alberta based organization dedicated to delivering exceptional customer experience and community leadership. We’re committed to providing the best health coverage to over 1.8 million members and take an active role in promoting wellness. We believe in what we do—and place trust in our employees to deliver our vision.

Working at Alberta Blue Cross® means having a career where you’ll be recognized for your contributions. We value diversity, encourage our team members to maintain a healthy work-life balance and provide opportunities for career growth.

OVERVIEW:

The Appeals Case Manager is responsible for reviewing, analyzing, and making decisions on appeals related to disability claims. This role ensures all appeals are handled in accordance with policy guidelines, regulatory standards, and industry best practices. Acting as a subject matter expert, the Appeals Case Manager collaborates with internal teams to resolve complex cases, support quality assurance and audit efforts, and drive continuous improvement in claims processes. Strong analytical skills, sound judgment, and a commitment to service excellence are essential to effectively balance client needs with organizational standards, audit readiness, and compliance requirements.

WHAT YOU WILL DO:

• Serve as a subject matter expert on appeals, ensuring adherence to service level agreements, policy guidelines, and industry standards including CLHIA regulations.
• Render decisions on appeals in accordance with Group Policy provisions, industry best practices and documented procedures.
• Measure claims quality against established performance standards and best practices. Conduct quality assurance reviews and offer recommendations for improved service delivery.
• Act as a key resource within the team: assist with complex cases and concurrences and provide consultation on escalated claims.
• Support internal systems such as FINEOS by updating and validating information as required.
• Identify opportunities for continuous improvement and contribute to service delivery enhancements and process efficiencies across claims and appeals functions.
• Collaborate cross-functionally with the Disability Operations team to support business retention, growth, and client satisfaction.
• Demonstrates up-to-date knowledge of legislative changes, industry trends, and relevant case law, with the ability to apply this understanding to claims adjudication and appeals—ensuring decisions are timely, defensible, and aligned with best practices (e.g., late notice, limitation periods).
• Proactively address and resolve client needs or concerns escalated through the appeals process, ensuring high standards of service excellence are maintained.

WHAT YOU WILL HAVE:

• Minimum of five years of experience in group insurance with a focus on disability management.
• Comprehensive understanding of disability management strategies, claims adjudication, and appeals processes.
• Experience providing mentorship, training, or support to peers in a collaborative work environment.
• Exceptional verbal and written communication skills with strong interpersonal capabilities.
• Demonstrated initiative, sound judgment, and analytical problem-solving abilities.
• Ability to manage complex workloads in a fast-paced, dynamic environment while meeting deadlines and quality standards.
• Strong organizational and time management skills, with the ability to handle multiple priorities.
• Intermediate to advanced proficiency in Microsoft Office, particularly Excel and Word.
• Self-directed with a strong sense of accountability and demonstrated flexibility and innovation.

This position will remain open until October 10, 2025.

Alberta Blue Cross® is an inclusive employer committed to a workplace that reflects the diversity of the communities we serve. We empower and are advocates for our team members by welcoming, respecting and valuing their unique perspectives, backgrounds, and experiences.

We offer the opportunity to work in an innovative, high-energy team-focused environment. If you have the qualifications we are looking for, apply online at careers.ab.bluecross.ca