Bilingual Investigative Analyst – Fraud Risk Management

Responsibilities   Conduct reviews of plan member and service provider claiming behavior to rule out fraud or abuse
Using data analysis and audit outcomes, recommend dental providers and clinics for investigation
Identify, track and communicate emerging fraud and abuse trends
Triage tips and referrals related to inappropriate administration practices of dental providers
Provide support to the Investigator on active profiling of dental providers
Assist in interviewing plan members and prepare packages for onsite audits
Timely collection and documentation of investigative steps and outcomes
Action and respond to inquiries and escalations
Confidently communicate audit findings to a variety of audiences
Promote education and awareness related to fraud prevention
Requirements   Bilingualism (French, English, both oral and written) is required
Minimum of two years dental industry expertise
Excellent communications skills both verbal and written
Strong knowledge of dental benefits and dental terminology
Ability to work independently in a fast‑paced environment
Strong decision‑making skills and attention to detail
Advanced computer skills (Word, Excel, Tableau, Outlook)

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