Investigation Analyst in Provider Risk at Manulife focusing on fraud prevention, detection, and investigation in the healthcare sector, working with internal teams and stakeholders.
Responsibilities
Perform risk-based data profiling to identify trends and outliers, leading investigations to successful conclusions, including preparing criminal and regulatory complaints.
Lead and support audit programs by coordinating, assessing, and making decisions on investigations, and conducting interviews with plan members and service providers.
Create written audits and correspondence for plan members and service providers, while engaging with internal and external stakeholders to ensure comprehensive investigation processes.
Requirements
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
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
Benefits
health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage
adoption/surrogacy and wellness benefits
employee/family assistance plans
various retirement savings plans (including pension and a global share ownership plan with employer matching contributions)
financial education and counseling resources
generous paid time off program including holidays, vacation, personal, and sick days, and the full range of statutory leaves of absence
Field Risk Engineer at AIG conducting property loss prevention surveys and developing mitigation strategies for various commercial facilities, ensuring effective risk management solutions.
Operations Control Lead managing risk and control activities across North America operations. Overseeing risk assessments, testing programs, and team of Control Testing Specialists.
Werkstudent in Fonds Governance supporting investment management processes at a leading investment firm. Collaborate on fund management and assist in operational implementations.
Senior Governance Analyst managing contracts, suppliers, and internal support in São Paulo. Focused on process improvement and analytical reporting in a hybrid work environment.
Senior Officer at Citi managing the day - to - day execution of Wealth’s risk management framework. Analyzing data to identify and mitigate risks while ensuring policy compliance and stakeholder engagement.
Assistente de Gestão de Risco at Boon supporting analysis and control of health plan usage and indicators. Responsible for organizing data, reports, and assisting medical and actuarial areas.
Support implementation of risk management and internal control systems at BASF. Collaborating across the organization to optimize processes, drive awareness, and deliver training.
Team Lead for Risk Management System (RMS) and Internal Control System (ICS) at BASF, managing risk strategy, compliance, and standards while leading a dedicated team.
Risk Management Specialist performing fraud analysis for Greenlight, a family fintech company. Supporting customer service and improving fraud detection processes for efficient operations.
Risk Intern working on data - driven projects across Operational, Divisional, and Technology Risk at S&P Global. Engaging in analysis, reporting, and cross - functional collaboration.