LTC Fraud Consultant

Manulife•New York, MA

5d•$73,350 - $122,250•Remote

About The Position

We’re looking for a detail-oriented, analytical LTC Fraud Consultant to help strengthen our Long-Term Care (LTC) Fraud, Waste & Abuse (FWA) program. In this role, you’ll turn claims and operational data into insights that support investigations, surface emerging fraud trends, and improve processes and controls across the program.

Requirements

3–5 years of experience in Long-Term Care (LTC), healthcare/insurance business analysis, and/or Fraud, Waste & Abuse (FWA)
Strong analytical and critical-thinking skills; able to interpret complex claims and operational data
Ability to translate findings into clear artifacts (business requirements, user stories, process flows)
Advanced Excel skills and comfort with large datasets; familiarity with SQL/SAS and/or BI tools (Power BI/Tableau) a plus
Clear written and verbal communicator; able to work effectively with both technical and non-technical stakeholders while managing multiple priorities
Experience with fraud investigations/SIU and familiarity with Medicaid and/or commercial LTC benefits and fraud/case management tools preferred

Responsibilities

Lead targeted customer outreach to explain updated claim reimbursement controls, drive adoption, and support understanding and compliance.
Spend approximately 60% of the role on the phone conducting customer outreach related to claim reimbursement controls, education, and support.
Analyze LTC claims and provider billing patterns to identify potential fraud, waste, and abuse.
Prepare data extracts, dashboards, and concise analytic summaries to support case development and investigations.
Monitor and communicate emerging fraud schemes; help design mitigations, controls, and process improvements.
Partner cross-functionally with investigators, clinical teams, and technology teams to improve fraud operations and detection capabilities.
Gather and document business needs (requirements, user stories, process flows) for enhancements to fraud detection and case management tools.
Support performance monitoring and reporting for the LTC FWA program, and contribute to continuous improvement across fraud operations.