LTC Fraud Investigator

Manulife • Usa, MA

17h • Remote

About The Position

We’re looking for a detail-oriented, analytical LTC Fraud Investigator 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

Nice To Haves

• 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.
• 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.

Benefits

• health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans.
• various retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions) and financial education and counseling resources.
• up to 11 paid holidays, 3 personal days, 150 hours of vacation, and 40 hours of sick time (or more where required by law) each year
• full range of statutory leaves of absence

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed