• Employer: iA Financial Group
• Office: 1981 McGill College Avenue
• Location: Montreal, Quebec
• Other Possible Location(s): Toronto, Ontario; Québec, Quebec
• Job category: Claims - Health Insurance
• Job ID: JR10024054
• Job type: Permanent Job
• Apply before: 2025-09-26

Description

***Sector:***Health and Dental Claims / Permanent Position / Hybrid / Québec / Montréal / Toronto / Start Date: As soon as possible

You are recognized for your expertise in drug management, your analytical rigor, and your ability to harmonize practices. We have the perfect challenge for you! Reporting to the Assistant Director of Specialized Operations, you will be responsible for ensuring strategic alignment between the Claims and Product teams, managing complex cases, and supporting the evolution of coverage policies.

Responsibilities:

• Collaborate closely with the Product team to interpret, apply, and evolve prior authorization criteria.
• Ensure smooth integration of new criteria into claims processes.
• Review reimbursement requests for medications exceeding $100,000.
• Triage complex cases requiring in-depth analysis or cross-functional coordination.
• Contribute to decision-making regarding drug coverage and prior authorizations.
• Harmonize practices among PA analysts to ensure consistency in decisions and communications.
• Analyze trends in processed requests to identify improvement opportunities.
• Support analyst training and contribute to team skill development.
• Respond to complex internal partner inquiries (e.g., coverage, eligibility, complaints).
• Act as a reference expert for cases requiring nuanced policy interpretation.
• Document special cases and decisions made.
• Serve as a point of contact with ESC and participate in operational meetings.
• Actively contribute to the PA roadmap.

Desired profile:

• Education in pharmacy, management, or a related field, with several years of relevant experience.
• Excellent knowledge of drug evaluation criteria and coverage policies.
• Ability to analyze complex cases and make informed decisions.
• Strong communication and cross-functional collaboration skills.
• Autonomy, rigor, and organizational skills.
• Ability to work in a changing environment and support transformation.
• Proficiency with office tools and claims management systems.
• Advanced level of English required, as the role involves writing documentation in English, participating in meetings, and communicating via email or video conference with English-speaking teams in Ontario on a daily basis.
• Intermediate level of French required – both spoken and written.

Invest in your talent by joining our team

See why so many people choose iA!

Company Overview

iA Financial Group is the strength of a company with a human side, with its over 10,000 employees. Together, we have earned the trust of our more than five million clients and 50,000 advisors who have chosen us for their insurance, savings, and wealth management.

With over $235 billion in assets, we’re a key player in the financial services industry in Canada and the United States. The secret to our success? Investing in you, one person at a time. Because, for over 130 years, we have believed that it’s by supporting our employees and surrounding ourselves with the most reputable leaders in the industry, we will continue to innovate.

At iA, we’re invested in you.

Our commitment to Diversity and Inclusion

At iA Financial Group, we support and celebrate diversity. We strive to provide a workplace that is recognized as inclusive for all, regardless of ethnic origin, nationality, language, religious beliefs, gender, sexual orientation, age, marital status, family situation, or physical or mental disability.

Please note that if you need help or assistance to make the recruitment process more accessible for you, write to us. Someone from our team will be happy to assist you.