LTC Fraud Investigator

Overview

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.

• 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.

• 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

• 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.

This posting supports an ongoing hiring initiative for existing and/or future vacancies.

Manulife Financial Corporation is a leading international financial services provider. To learn more about us, visit our website.

Manulife/John Hancock is an Equal Opportunity Employer. We strive to foster an inclusive work environment and comply with applicable laws regarding non-discrimination.

A Human Resources representative will assist applicants requesting a reasonable accommodation during the application process. To request an accommodation, contact