Bilingual Investigative Analyst - Fraud Risk Management
About The Position
Fraud management is increasingly important to policyholders. To serve Sun Life’s clients as industry leaders, Canadian Operations’ Fraud Risk Management area will identify, mitigate and respond to criminal threats using various tools, technologies and strategies. Reporting to the Manager for Fraud Risk Management, the Bilingual Investigative Analyst will work in partnership with Investigators in the identification and investigation of situations involving suspected dishonest, fraudulent and abusive claiming activities pertaining to dental service providers, clinics and plan members. Applying attention to detail and quick decision-making, the successful candidate will complete several daily tasks, largely focusing on reviewing dental claims for flags representing unusual claiming situations and performing audits. The successful incumbent will collaborate across teams in the prevention and detection of fraud and abuse within the dental landscape.
Requirements
- Bilingualism (French, English, both oral and written) is required for the frequent interactions with English and French-speaking colleagues or internal partners across Canada and worldwide.
- Minimum of two years dental industry expertise attained through experience working in a dental office.
- Excellent communications skills both verbal and written.
- Strong knowledge of dental benefits and dental terminology.
- Needs to be able to work independently within a fast-paced environment and participate in opportunities to share and learn through group collaboration.
- Knowledge and understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry.
- Strong decision-making skills and attention to detail.
- Advanced computer skills (Word, Excel, Tableau, Outlook).
Nice To Haves
- Experience working within audit or investigations.
- University degree or postsecondary education.
Responsibilities
- Conduct reviews of plan member and service provider claiming behavior to rule out fraud or abuse.
- Using data analysis and audit outcomes, recommend dental providers and clinics for investigation.
- Identify, track and communicate emerging fraud and abuse trends.
- Triage tips and referrals related to inappropriate administration practices of dental providers.
- Provide support to the Investigator on active profiling of dental providers.
- Assist in interviewing plan members and prepare packages for onsite audits.
- Timely collection and documentation of investigative steps and outcomes.
- Action and respond to inquiries and escalations.
- Confidently communicate audit findings to a variety of audiences including plan members, service providers and management.
- Assist in the preparation of delist recommendations, regulatory complaints and criminal briefs.
- Promote education and awareness to internal and external stakeholders related to fraud prevention.
- Make recommendations for continuous improvement.
- Keep up to date on trends and schemes impacting benefit plans.
Benefits
- A friendly, collaborative and inclusive culture
- A collaborative and interactive team environment
- Being part of our journey in developing the next greatest digital experience
- Working together, sharing common values and encouraging growth & achievement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
