Hybrid Manager, Fraud Risk Management

at Sun Life

• Job title: Manager, Fraud Risk Management
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: CA$80,000 - CA$128,000 per year
• Degree requirement: Bachelor's Degree
• Tech skills: Tableau
• Location requirements: Hybrid, Waterloo, Canada

About the role

• Manager leading a team for fraud risk management at Sun Life. Overseeing proactive fraud prevention efforts and utilizing advanced analytics in health benefits.

Responsibilities

• Provide leadership to a team of investigative analysts and investigators focused on proactive due diligence and early detection of collusion-based fraud schemes
• Drive the strategic use of advanced analytics to identify high-risk providers and suspicious patterns before significant losses occur
• Oversee the preparation of delists, regulatory complaints and police referrals
• Measure and report on the effectiveness of proactive fraud prevention initiatives, demonstrating return on investment and loss avoidance
• Develop the team's competencies in advanced analytics, investigative techniques, and emerging fraud detection methodologies to fully utilize individual team members' strengths and talents
• Lead and support direct reports in executing quality service delivery, providing direction, setting clear expectations, coaching, being available, providing recognition and holding individuals accountable for results
• Conduct regular assessments on the quality of documentation, risk-based prioritization of investigations and decisions made on cases
• Champion a culture of continuous improvement and innovation to deliver on the ever-evolving expectations of our plan members and plan sponsors on fraud and abuse matters
• Participate in projects involving new technologies, processes and practices
• Monitor emerging trends in health care to identify potential risk of misuse or abuse of health and dental claims.

Requirements

• Bilingualism (French, English, both oral and written) is required for Quebec only
• Experience leading a team focused on fraud and abuse management, criminal investigations or equivalent
• Proficiency in data analytics and data interpretation for fraud detection purposes
• Strong analytical skills and critical thinking with attention to accuracy and details
• Knowledge of group insurance business (products, services, distribution, organization, systems, processes) and regulatory environments
• Understanding of extended health benefits, billing practices, and health related fraud schemes
• Strong leadership skills, ability to influence solutions and facilitate cross-departmental teamwork that meets the needs of the business strategy
• Excellent communication skills (written and verbal) and experience presenting sensitive matters to customers or senior management
• Proven presentation skills
• Solid decision-making skills by understanding and assessing business needs and risks
• Superior organizational skills and ability to multi-task, prioritize initiatives and execute effectively
• Experience with case management systems and fraud detection software
• Advanced computer skills (Excel, Tableau, or similar analytical tools)
• University degree or postsecondary education
• Experience implementing or managing proactive fraud prevention programs
• Certifications such as CFE (Certified Fraud Examiner), CFCI (Certified Financial Crimes Investigator), or similar credentials
• Fluency in two or more languages
• Must be able to obtain RCMP Reliability Security Clearance before a start date can be confirmed (includes fingerprinting).

Benefits

• Flexible Benefits from the day you join to meet the needs of you and your family
• A caring, supportive, and inclusive culture