Manulife's Group Benefits Health and Dental Claims Risk Management team focuses on digital claims risk management, fraud investigations, and data analytics to support key operational objectives. The Investigation Analyst – Provider Risk plays a crucial role in preventing, detecting, and investigating fraud and abuse among healthcare providers, implementing risk mitigation strategies to protect benefit plans.
This position involves collaboration with internal departments and external contacts, reporting to the Senior Manager, Fraud Risk Management, and is key to safeguarding plan sponsors and members from claims fraud. If you have an investigative spirit and strong analytical skills in the Canadian Health Care Industry, this role might be for you.
Position Responsibilities:
Data Analysis and Investigation
:
Perform risk-based data profiling to identify trends and outliers, leading investigations to successful conclusions, including preparing criminal and regulatory complaints.
Audit Leadership
:
Lead and support audit programs by coordinating, assessing, and making decisions on investigations, and conducting interviews with plan members and service providers.
Communication and Reporting
:
Create written audits and correspondence for plan members and service providers, while engaging with internal and external stakeholders to ensure comprehensive investigation processes.
Required Qualifications:
Knowledge of Group Benefits
Knowledge of the Canadian healthcare environment, service delivery model and regulation
University degree or equivalent work experience
CFE designation is an asset
Knowledge of fraud and abuse risk, and techniques to manage risk
Preferred Qualifications:
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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About Manulife and John Hancock
Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit .
Manulife is an Equal Opportunity Employer
At Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.
It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact
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