LTC Fraud Investigator
Manulife•Time, IL
•$73,350 - $122,250•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
- 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
- employee/family assistance plans
- retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions)
- financial education and counseling resources
- up to 11 paid holidays
- 3 personal days
- 150 hours of vacation
- 40 hours of sick time (or more where required by law) each year
- full range of statutory leaves of absence
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
