Complex Investigative Review Specialist

Canada Life; Regina; Hybrid; CAD 50,000 - 84,000; Full time

Job summary

A leading company is seeking an Investigator 3 for its Fraud Management team. This hybrid role involves conducting complex investigations of healthcare fraud, requiring strong analytical skills and attention to detail. The successful candidate will document findings and collaborate with various stakeholders while ensuring compliance with established protocols. The position offers competitive rewards and opportunities for professional development.

Benefits

Tuition reimbursement

Bonuses

Paid vacation

Personal days

Volunteer days

Access to sports leagues

On-site fitness

Cafeteria

Qualifications

• 5+ years of related experience in health/dental claims fraud investigations.
• Ability to work collaboratively in a team.

Responsibilities

• Conduct thorough investigations into suspected fraud and abuse of health/dental insurance benefits.
• Analyze financial records and claims data.

Skills

Communication

Analytical Skills

Problem Solving

Attention to Detail

Customer Service

Education

Post-secondary education

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

Permanent Full Time

We are currently hiring for an Investigator 3 within Fraud Management, Workplace Solutions.

The Investigator 3 role is a key member of the Fraud Management team and will be responsible for conducting large-scale and complex investigations of healthcare providers and plan members, assessing case information, formulating investigative plans, collecting evidence, and taking appropriate actions based on findings.

To be successful in this role, you must possess superior written and verbal communication, analytical and problem-solving skills, attention to detail, and the ability to accurately and thoroughly document case information and findings.

This is a hybrid position – the successful applicants will be required to work 3 days a week in the office with flexible working hours within our core business hours of 7am-5pm CST.

What you will do:

• Conduct thorough investigations into suspected fraud and abuse of health/dental insurance benefits, identified through various detection channels
• Analyze and interpret financial records, claims data, and information from internal and external sources
• Develop and execute investigative plans to obtain evidence where fraud or abuse is suspected
• Communicate with appropriate parties (verbal and/or written), including plan members, claimants, and providers
• Work collaboratively with the industry and internal Fraud Management team including leaders, other investigators, and intelligence analysts
• Consult with Health and Dental subject matter experts, internal medical boards, regulatory bodies, Legal, or other departments as warranted
• Accurately document investigative actions and outcomes according to department best practices
• Determine and execute appropriate actions based on evidence, following established protocols
• Create comprehensive summaries regarding investigative findings to support reporting, recovery, legal actions, and labor relations
• Identify opportunities to mitigate future risks
• Collaborate on special projects, including targeted investigations and process improvements
• Participate in training and mentorship for team members
• Stay current on industry trends and maintain professional development

What you will bring:

• Due to high-profile clients, a Federal Government Enhanced Screening, including fingerprinting and credit check, is required
• 5+ years of related experience leading investigations into complex health and/or dental claims fraud
• Proven ability to work collaboratively in a team
• Strong understanding of Group and Individual health and dental insurance
• Post-secondary education (degree/diploma) or relevant experience combined with education
• Solution-oriented with decision-making, problem-solving, and analytical skills
• Strong customer service mindset
• Excellent verbal and written communication skills in fast-paced, unscripted situations
• Organizational and time management skills, capable of managing multiple investigations
• Proficiency in Microsoft Excel, Word, and Outlook
• CFE or relevant professional designation is an asset
• Bilingual in English and French is an asset

Benefits:

• Challenging work in a dynamic, collaborative, and growing team
• Supportive leadership and development opportunities
• Competitive rewards including tuition reimbursement, bonuses, and benefits
• Paid vacation, personal days, and volunteer days
• Participation in team-building and professional development activities
• Access to sports leagues, on-site fitness, and cafeteria

The base salary ranges from $50,400.00 to $83,900.00 annually, excluding variable components like bonuses or commissions. Further details will be discussed during the recruitment process.

Applications are reviewed on a rolling basis, with a minimum of 5 business days from posting. We encourage you to apply today and be your best at Canada Life!