Analyste en Enquête, Médicaments

Company 1 - The Manufacturers Life Insurance Company; Southwestern Ontario; Hybrid; CAD 51,000 - 86,000; Full time

Job summary

A leading insurance provider in Ontario is seeking a professional for a hybrid role in their Group Benefits Health and Dental Claims Risk Management department. The successful candidate will be responsible for risk-based data profiling, conducting audits, and leading investigations related to fraud and abuse in drug claims. Candidates should have post-secondary education and a background in pharmacy or related fields along with strong analytical and communication skills.

Benefits

Customizable health and dental benefits

Flexible working environment

Retirement savings plans

Qualifications

• Pharmacy technician or pharmacy assistant background would be an asset.
• General understanding of medical terminology, diseases, and drug formularies.

Responsibilities

• Perform risk-based data profiling and analysis to identify trends.
• Lead and support audit programs and make decisions on investigations.
• Conduct interviews and create written audits.
• Provide technical expertise to troubleshoot claims payment.

Skills

Negotiation skills

Analytical skills

Problem-solving skills

Presentation skills

Project management

Communication skills

Education

Post-Secondary education or equivalent experience

Tools

Excel

Data mining software

Job description

Overview

Join a dynamic team within the Group Benefits Health and Dental Claims Risk Management department, where we deliver a broad range of services including digital claims risk management, fraud investigations, data analytics, and claims experience oversight. This role plays a critical part in identifying and mitigating fraud and abuse in drug claims, contributing to the integrity and sustainability of our benefits programs.

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 independently lead investigations to successful conclusion
• Conduct interviews of plan members, providers of service and others as required
• Create written audits and other correspondence to plan members, providers of service and others
• Engage / interact / consult with various internal contacts such as Customer Service, Legal, Client Relations, Medical Consultants, Regional Group Office, and external stakeholders such as Health Practitioner Regulatory Bodies, Colleges and Associations, and Plan Sponsors
• Lead, support and implement key investigative projects
• Provide technical expertise to internal customers to troubleshoot claims payment, resolve escalated complaints, support issue trends etc.
• Provide oversight of the drug audit program and risk assessment of claim initiatives and client customizations that relate to the drug benefit
• Review and analyze high dollar drug claims and narcotics usage
• Attend client meetings as required
• Attend litigation / arbitration sessions in court if required

Required Qualifications

• Post-Secondary education or equivalent experience - pharmacy technician or pharmacy assistant background would be an asset
• General understanding of medical terminology, diseases, and drug formularies

Preferred Qualifications

• Good presentation and negotiation skills
• Strong analytical, research, problem-solving and decision-making skills
• Effective project management capabilities
• Ability to review and analyze critical data to make formal recommendations for process improvements
• Comfortable speaking with external parties such as pharmacists, health care providers, drug manufacturers, government agencies, plan members and plan sponsors etc.
• Must be able to decipher health industry information and understand how it relates to Group Benefits' plans
• Proven ability to manage / schedule a fluctuating, unpredictable and stressful workload

Knowledge of Group Benefits

• Knowledge of the Canadian healthcare environment, service delivery model and regulation
• Excellent understanding of third-party claims adjudication as it relates to Pharmacy benefits
• 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
• Intermediate data analysis skills with expertise using Excel and other data mining software
• Demonstrate investigation skills with attention to detail
• Knowledge of privacy, civil and criminal legal risks and processes

When you join our team

We’ll empower you to learn and grow the career you want.

We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.

As part of our global team, we’ll support you in shaping the future you want to see.

#LI-HYBRID

About Manulife and John Hancock

Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit .

Equal Opportunity Employment

Manulife is an Equal Opportunity Employer. At Manulife / John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.

It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife / John Hancock policies. To request a reasonable accommodation in the application process, contact .

Referenced Salary Location

Montreal, Quebec

Working Arrangement

Hybrid

Salary range is expected to be between

$51,375.00 CAD - $85,625.00 CAD

If you are applying for this role outside of the primary location, please contact for the salary range for your location. The actual salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education / training. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.

Manulife offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption / surrogacy and wellness benefits, and employee / family assistance plans. We also offer eligible employees various retirement savings plans (including pension and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in Canada includes holidays, vacation, personal, and sick days, and we offer the full range of statutory leaves of absence. If you are applying for this role in the U.S., please contact for more information about U.S.-specific paid time off provisions.