Senior Associate role within PwC Risk Consulting assisting clients in internal audit and risk management strategies. Responsible for improving internal controls and mitigating risks across diverse teams.
About the role
- Investigation Analyst role in health and dental claims risk management at Manulife. Focus on fraud detection and mitigation in a dynamic team environment.
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 conclusions 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
Requirements
- Knowledge of Group Benefits
- University degree or equivalent work experience
- Knowledge of the Canadian healthcare environment, service delivery model and regulation
- Excellent oral communication (both phone and face-to-face) and written communication skills
- Knowledge of fraud and abuse risk, and techniques to manage risk
- CFE designation is an asset
- Organizational skills and the ability to manage multiple conflicting priorities
- Demonstrated investigation skills with attention to detail
- Strong research, problem-solving and decision-making skills
- Intermediate or higher data analysis skills with expertise using Excel and other data mining software
- Ability to manage contentious interactions with various stakeholders
Benefits
- Health, dental, mental health, vision insurance
- Short- and long-term disability insurance
- Life and AD&D insurance coverage
- Adoption/surrogacy and wellness benefits
- Employee/family assistance plans
- Retirement savings plans
- Pension plan with employer matching contributions
- Financial education and counseling resources
- Generous paid time off program including holidays, vacation, personal, and sick days
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