Manulife’s Group Benefits Health and Dental Claims Risk Management department is a diverse and dynamic team delivering a broad range of services in support of key operational objectives. Our responsibilities include digital claims risk management, claims abuse management and monitoring programs, fraud investigations, data analytics, and claims experience management. The effective management of health and dental claims experience is imperative to the success of the group benefits operations.
The Investigation Analyst will draw on their in-depth analytical skills, investigative mindset, customer focus, group benefits background and understanding of the Canadian Healthcare environment/regulation to help manage ongoing priorities in the delivery of risk management.
A key focus of the Investigation Analyst is the prevention, detection, and investigation of fraud and abuse specific to health care providers. This role will proactively identify risk, champion mitigation strategies, conduct provider investigations and take actions to protect Manulife benefit plans from fraud. The role may liaise externally with industry contacts and vendors, and internally with Legal, Compliance, Advanced Analytics, Marketing, Customer Service, Client Relations, Ombudsman and the Field as needed.
This role reports to the Senior Manager, Fraud Risk Management, and helps to protect plan sponsors and members from the negative impacts of claims fraud. This role is focused on provider risk mitigation, which is a key part of the foundation for our investigation programs and a vital part of claims risk management.
Position 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 conclusion including the preparation of criminal and regulatory complaints
Conduct interviews of 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 may be required for this role including the ability to work outside of core working hours
Required Qualifications:
Knowledge of Group Benefits
Knowledge of the Canadian healthcare environment, service delivery model and regulation
University degree or equivalent work experience
Preferred Qualifications:
Bilingualism (English and French) is an asset. If the successful candidate is in Québec, proficiency in both languages will be required to support clients from various provinces outside of Quebec.
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 or higher data analysis skills with expertise using Excel and other data mining software
Demonstrated 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
When you join our team:
We’ll empower you to learn and grow the career you want.
We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.
As part of our global team, we’ll support you in shaping the future you want to see.
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The role being advertised is an existing vacancy.
About Manulife and John Hancock
Manulife Financial Corporation is a leading international financial services provider, helping…
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