Prevention and Detection Assesor

at  Cowan Insurance Group

The Prevention and Detection Assessor, reporting to the Manager, TPA Claims will be responsible for conducting audits for client of Cowan Insurance and will assist with Provider Profiling and Auditing.

WHO WE ARE:

Proudly independent and Canadian-owned, Cowan Insurance Group has been a true market leader in the insurance industry since 1927. With an extensive range of product offerings and integrated commercial and personal insurance, group benefits, and wealth management solutions, we provide our clients with outstanding customized, comprehensive insurance and risk management professional advice and placement.
Recognized as one of Canada’s Most Admired Cultures and a Canada’s Best Managed Companies Platinum Club Member, Cowan Insurance Group’s award-winning client-centric approach emphasizes innovation, excellence, and collaboration. Join our team as we prepare for our centennial celebration in 2027!

• Conduct Audits by reviewing healthcare provider claims, medical records, and billing information to ensure accuracy and compliance with applicable regulations.
• Identify discrepancies, errors, potential fraud in billing and coding practices.
• Prepare detailed reports summarizing all audit findings, including billing patterns, issues, errors, and potential abuse.
• Provide recommendations for correcting errs and preventing future issues.
• Stay updated on provincial healthcare regulations and respective changes to provincial medical plans
• Responsible for Provider Profiling, including new and existing providers.
• Establishing clear guidelines for acceptable provincial billing practices.