Claim Investigation Analyst
About The Position
Manulife’s Customer Experience Investigation Services department, an industry leader in fraud prevention, is looking for a dynamic individual to join its team. This department is dedicated to preventing, detecting and investigating incidences of fraud and abuse against its benefit plans. The Investigation Analyst, Investigation Services is responsible for applying Group Benefits knowledge, attention to detail, problem solving abilities, customer service, investigation and data analysis skills to identify, investigate and prevent fraud and abuse. Additionally, this role will support the Manager with projects and initiatives.
Requirements
- University degree or equivalent work experience
Nice To Haves
- Knowledge of Group Benefits
- Knowledge of the Canadian healthcare environment, service delivery model and regulation
- CFE designation is an asset
- Knowledge of fraud and abuse risk, and techniques to manage risk
- Strong research, problem solving and decision-making skills
- Ability to manage contentious interactions with various stakeholders
- Excellent oral communication (both phone and face to face) and written communication skills
- Intermediate data analysis skills with expertise using Excel and other data mining software
- Demonstrate investigation skills with attention to detail
- Ability to be creative, critical and aggressive in managing audit and investigative activities
- Organizational skills and the ability to manage multiple conflicting priorities
Responsibilities
- Perform risk-based data profiling and analysis to identify trends and outliers in various categories for further review and investigation
- Lead and support audit programs; coordinating, assessing, and making decisions on investigations
- Take initiative and lead investigations to successful conclusions including the preparation of criminal and regulatory complaints
- Conduct interviews with plan members, providers of service and others
- Create written audits and other correspondence to plan members, providers of service and others
- Engages, interacts and consults with various internal contacts such as Customer Service, Legal, Client Relations, Medical Consultants, Regional Group Office and external stakeholders such as Health Practitioner Regulatory Bodies, Colleges and Associations, and Plan Sponsors
- Lead, support and implement key investigative projects
- Comfortable delivering effective presentations to new and existing clients
- Travel is required for this role, including the ability to work outside of core working hours
Benefits
- health
- dental
- mental health
- vision
- short- and long-term disability
- life and AD&D insurance coverage
- adoption/surrogacy and wellness benefits
- employee/family assistance plans
- various retirement savings plans (including pension and a global share ownership plan with employer matching contributions)
- financial education and counseling resources
- holidays
- vacation
- personal
- sick days
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
