Quality Assurance Advisor

At Pacific Blue Cross, we're committed to improving the health and wellbeing of British Columbians. Delivering on that commitment means ensuring our claims management practices are consistent, compliant, and focused on delivering quality outcomes for our members.
We're looking for an experienced Quality Assurance Advisor to bring their Disability Management and claims expertise into a role where they can have a broader impact across our operations.
This is an exciting opportunity for an experienced Disability Management professional who is ready to step away from day-to-day claims adjudication and use their expertise in a different way. You'll independently conduct quality assurance reviews, claims file audits, compliance reviews, and evaluations of claims management practices, turning your findings into meaningful recommendations that strengthen how we work.
Reporting to the Senior Manager, Continuous Improvement, you'll work closely with operational managers to identify trends and opportunities, share findings, and provide insights that support training, performance management, compliance, and continuous improvement.
This role is ideal for someone who has deep Disability Management experience, strong judgement, and the confidence to provide constructive feedback in a way that is both compassionate and clear. You'll work independently, manage your own portfolio of reviews, and have the opportunity to influence claims practices without having direct reports.
If you've held roles such as Disability Management Specialist, Disability Case Manager, Senior Disability Case Manager, Claims Quality Assurance Specialist, Claims Quality Analyst, Claims Auditor, Disability Claims Auditor, Quality Assurance Advisor, Claims Consultant, or Disability Management Consultant, we'd love to hear from you.
Position Title:
Quality Assurance Advisor
Work Arrangement:
Hybrid - 3 days in the office and 2 days’ work from home
Classification:
Exempt
Salary Range:
$ 90,000 - $110,000 (Pacific Blue Cross’ compensation program is built on a pay-for-performance philosophy, rewarding both individual and organizational achievements. We determine starting salaries by considering a variety of factors, including relevant skills, education, experience, and internal equity, ensuring compensation decisions are consistent, equitable, and reflective of each candidate’s unique background and qualifications)
Incentive Compensation Plan (ICP bonus) per year based on performance:
Up to 1 0 %
Total Rewards Highlights
Flexible working hours of 7.5 hours per day, Monday to Friday (i.E., 37.5 hours per week).
Paid vacation starts at 4 weeks per year and increases with years of service.
Generous benefits, including extended health, dental, and life insurance;
depending on the plan that you choose, these benefit premiums can be 100% paid by PBC.
PBC contributes the equivalent of 8% of your base salary to a Defined Contribution pension plan. No employee contribution or matching is required, giving you more take-home pay
About Pacific Blue CrossPacific Blue Cross (PBC) has been British Columbia’s leading benefits provider for over 80 years. We are an independent, not-for-profit society with strong roots in BC’s health care system.
Why You'll Love Working Here
Retiree Benefits plan that is available to employees who have at least 10 years of service with PBC and have reached the age of 55.
Access to an onsite fitness center and cafeteria, along with employee events and activities designed to foster a collaborative and engaging work environment.
Access to virtual doctors/counsellors 24/7 via our Employee Family Assistance Program!
Learning and development opportunities
Wellness initiatives and onsite amenities
Keyways This Position Makes an ImpactSuccess in this role means providing timely, objective, and meaningful evaluation of our claims management practices to support quality, compliance, and continuous improvement. Through independent audits and file reviews, you'll identify trends and opportunities, provide actionable recommendations, and help operational leaders strengthen claims practices and team capabilities.
In this position, you will:
Conduct independent quality assurance reviews and claims file audits, applying your Disability Management expertise to evaluate current claims management practices and identify areas of strength, risk, and opportunity.
Support ongoing compliance with insurance requirements, providing consistent quality assurance oversight and identifying areas requiring attention or improvement.
Turn audit findings into meaningful insights and recommendations, identifying trends and providing clear summaries that can inform training, performance management, and continuous improvement initiatives.
Partner with operational leaders to strengthen claims practices, communicating findings and recommendations in a compassionate, constructive, and confident manner that creates a psychologically safe environment for feedback and learning.
Drive continuous improvement across claims management, using your experience and observations to identify opportunities to strengthen processes, improve consistency, and support quality outcomes.
Coordinate and facilitate audit reviews conducted by internal and external shareholders (we have audits done by blue cross life regulary and the QA advisor is key to that)
Work with the Learning & Development Trainer to inform design of learning modules and continuous training requirements
What You'll BringRequired Qualifications
Certificate in Disability Management or a bachelor’s degree in Kinesiology, Health Sciences, or a related discipline.
5–8 years of related experience in short-term disability (STD), long-term disability (LTD), Life, Critical Illness, Accidental Death & Dismemberment (AD&D), waiver claims adjudication, and case management.
Minimum three years of experience in a Disability Case Manager role, with demonstrated experience managing complex disability claims.
Demonstrated experience in complex case management planning, intervention, modified work, and return-to-work programs for STD and LTD claims.
Experience conducting claims audits, quality assurance reviews, or file reviews within a claims management environment..
Ability to conduct detailed claims file reviews and audits, identify gaps and trends, and provide clear recommendations based on findings.
Ability to provide constructive feedback in a compassionate, respectful and firm manner that supports learning and continuous improvement.
Strong judgement and attention to detail, with the ability to objectively assess claims management practices and identify quality or compliance concerns.
Ability to work independently, effectively manage priorities and maintain a self-directed workload.
Strong relationship-building skills with the ability to communicate findings effectively and collaborate with operational managers and other stakeholders.
Diversity, Equity & InclusionAt Pacific Blue Cross, we are committed to creating a workplace where everyone feels valued, respected, and empowered to contribute. We welcome applications from all qualified candidates and are proud to be an equal opportunity employer.
We believe diversity, equity, and inclusion are essential to fostering innovation, collaboration, and a strong sense of belonging. Through ongoing learning, meaningful action, and community partnerships, we continue to build an inclusive culture where employees and members can thrive.
If you require accommodation at any stage of the recruitment process, please contact View email address on ca.hrm.tc. We are committed to providing accessible and inclusive candidate experience.
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