Investigation Analyst managing fraud and risk in healthcare claims for Manulife. Focusing on plan member risk mitigation involving fraud prevention and investigations.
Responsibilities
Perform risk-based data profiling and analysis to identify trends and outliers
Lead and support audit programs; coordinating, assessing, and making decisions on investigations
Conduct interviews of plan members, providers of service and others
Create written audits and other correspondence to plan members and providers
Engage and consult with various internal contacts and external stakeholders
Lead, support and implement key investigative projects
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 (preferred)
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 and written communication skills
Intermediate or higher data analysis skills with expertise using Excel and other data mining software
Benefits
Health, dental, mental health, and 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 including pension and global share ownership plan with employer matching contributions
Financial education and counseling resources
Paid time off including holidays, vacation, personal, and sick days
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