Investigation Analyst & Member Risk

Manulife; Southwestern Ontario; Hybrid; CAD 43,000 - 74,000; Full time

Job summary

A leading financial services firm seeks an Investigation Analyst to join their Group Benefits Health and Dental Claims Risk Management team. The role focuses on fraud prevention, detection, and investigation, requiring strong analytical skills and knowledge of the Canadian healthcare environment. Responsibilities include risk-based data analysis, managing audit programs, and conducting interviews with plan members. The position offers a hybrid working arrangement and a competitive salary range aligned with market conditions.

Benefits

Health insurance

Dental insurance

Paid time off

Retirement plans

Flexible working environment

Qualifications

• Knowledge of the Canadian healthcare environment.
• Demonstrated investigation skills with attention to detail.
• Ability to manage multiple conflicting priorities.

Responsibilities

• Perform risk-based data profiling and analysis.
• Lead and support audit programs.
• Conduct interviews of plan members and service providers.
• Create written audits and correspondence.

Skills

Knowledge of Group Benefits

Excellent oral communication

Excellent written communication skills

Knowledge of fraud and abuse risk

Intermediate data analysis skills

Education

University degree or equivalent work experience

Tools

Excel

Job description

Overview

Manulife’s Group Benefits Health and Dental Claims Risk Management department is a diverse and dynamic team supporting key operational objectives through digital claims risk management, claims abuse monitoring, fraud investigations, data analytics, and claims experience management. Effective management of health and dental claims is crucial for the success of group benefits operations. The Investigation Analyst leverages analytical skills, investigative expertise, customer focus, and knowledge of the Canadian Healthcare environment to manage ongoing risk management priorities.

A key focus is the prevention, detection, and investigation of fraud and abuse related to plan members, proactively identifying risks and championing mitigation strategies. This role involves conducting investigations and liaising with industry contacts, vendors, and internal departments like Legal and Compliance.

Reporting to the Senior Manager, Fraud Risk Management, the Analyst helps protect plan sponsors and members from claims fraud. Focused on plan member risk mitigation, this role is fundamental to the success of our investigation programs and claims risk management.

Position 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 lead investigations to successful conclusions including the preparation of criminal and regulatory complaints
• Conduct interviews of plan members, providers of service and others
• Create written audits and other correspondence to plan members, providers of service and others
• Engages, interacts and consults 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
• Comfortable delivering effective presentations to new and existing clients

Required Qualifications

• Knowledge of Group Benefits
• University degree or equivalent work experience
• Knowledge of the Canadian healthcare environment, service delivery model and regulation
• Excellent oral communication (both phone and face-to-face) and written communication skills
• Knowledge of fraud and abuse risk, and techniques to manage risk

Preferred Qualifications

• CFE designation is an asset
• Organizational skills and the ability to manage multiple conflicting priorities
• Demonstrated investigation skills with attention to detail
• Strong research, problem-solving and decision-making skills
• Ability to be creative, critical and aggressive in managing audit and investigative activities
• Intermediate or higher data analysis skills with expertise using Excel and other data mining software
• Ability to manage contentious interactions with various stakeholders

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.

Manulife is an Equal Opportunity Employer

Manulife/John Hancock embraces diversity and fosters an inclusive work environment. We are committed to fair recruitment, retention, advancement and compensation, and administer all practices without discrimination on race, ancestry, place of origin, colour, ethnic origin, citizenship, religion, sex, pregnancy, sexual orientation, gender identity, gender expression, age, disability, or any other ground protected by law. Reasonable accommodations during the application process are available; contact recruitment at [e-mail].

Location and Employment Details

Referenced Salary Location: Waterloo, Ontario

Working Arrangement: Hybrid

Salary range is expected to be between $43,875.00 CAD - $73,125.00 CAD. If applying outside the primary location, please contact [e-mail] for location-specific details. Actual salary varies by market conditions and factors such as knowledge, skills, qualifications, experience, and education/training. Eligible employees may participate in incentive programs.

Manulife offers a wide array of benefits including health, dental, mental health, vision, disability, life and AD&D insurance, retirement plans, and paid time off. For U.S. applicants, contact [e-mail] for U.S.-specific information.