Investigation Analyst & Member Risk

Manulife; Toronto; Hybrid; CAD 43,000 - 74,000; Full time

Job summary

A leading financial services provider in Toronto is seeking an Investigation Analyst for its Group Benefits Health and Dental Claims team. This role focuses on preventing and detecting fraud within claims, requiring strong analytical and investigative skills. The Analyst will conduct investigations, liaise with internal departments and regulatory bodies, and deliver presentations. A university degree and knowledge of the Canadian healthcare environment are essential. This position offers a hybrid work model and competitive compensation.

Benefits

Comprehensive health and dental benefits

Short and long-term disability coverage

Retirement savings plans

Generous paid time off

Qualifications

• Leverage analytical skills and investigative expertise.
• Excellent communication skills both verbally and in writing.
• Knowledge of Canadian healthcare and regulation.

Responsibilities

• Perform risk-based data profiling and analysis.
• Lead investigations and prepare regulatory complaints.
• Conduct interviews of plan members and service providers.

Skills

Knowledge of Group Benefits

Excellent oral and written communication

Fraud and abuse risk management

Organizational skills

Investigation skills

Education

University degree or equivalent work experience

Tools

Excel

Data mining software

Job description

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.

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Acerca de Manulife y John Hancock

Manulife Financial Corporation es un importante proveedor internacional de servicios financieros que ayuda a las personas a tomar decisiones de una manera más fácil y a vivir mejor. Para obtener más información acerca de nosotros, visite http://www.manulife.com .

Manulife es un empleador que ofrece igualdad de oportunidades

En Manulife/John Hancock, valoramos nuestra diversidad. Nos esforzamos por atraer, formar y retener una fuerza laboral tan diversa como los clientes a los que prestamos servicios, y para fomentar un entorno laboral inclusivo en el que se aprovechen las fortalezas de las culturas y las personas. Estamos comprometidos con la equidad en las contrataciones, la retención de talento, el ascenso y la remuneración, y administramos todas nuestras prácticas y programas sin discriminación por motivos de raza, ascendencia, lugar de origen, color, origen étnico, ciudadanía, religión o creencias religiosas, credo, sexo (incluyendo el embarazo y las afecciones relacionadas con este), orientación sexual, características genéticas, condición de veterano, identidad de género, expresión de género, edad, estado civil, estatus familiar, discapacidad, o cualquier otro aspecto protegido por la ley vigente.

Nuestra prioridad es eliminar las barreras para garantizar la igualdad de acceso al empleo. Un representante de Recursos Humanos trabajará con los solicitantes que requieran una adaptación razonable durante el proceso de solicitud. Toda la información que se haya compartido durante el proceso de solicitud de adaptación se almacenará y utilizará de manera congruente con las leyes y las políticas de Manulife/John Hancock correspondientes. Para solicitar una adaptación razonable en el proceso de solicitud, envíenos un mensaje a [e-mail] .

Referenced Salary Location

Waterloo, Ontario

Modalidades de Trabajo

Híbrido

Salary range is expected to be between

$43,875.00 CAD - $73,125.00 CAD

Si se está postulando para este puesto fuera de la ubicación principal, póngase en contacto con [e-mail] para conocer el rango salarial de su ubicación. El salario real variará según las condiciones locales del mercado, la geografía y los factores relacionados con el trabajo pertinentes, como conocimiento, habilidades, calificaciones, experiencia y educación/capacitación. Los empleados también tienen la oportunidad de participar en programas de incentivos y obtener una compensación de incentivos vinculada al desempeño comercial e individual.

Manulife ofrece a los empleados aptos una amplia variedad de beneficios personalizables, entre ellos, beneficios de salud, odontológicos, de salud mental, oftalmológicos, por discapacidad a corto y a largo plazo, cobertura de seguro de vida y por muerte accidental y desmembramiento, adopción/subrogación y bienestar, y planes de asistencia al empleado/familiar. También ofrecemos a los empleados admisibles varios planes de ahorro para la jubilación (incluidos planes de pensiones y un plan mundial de propiedad de acciones con contribuciones equivalentes del empleador) y recursos de asesoramiento y educación financiera. Nuestro generoso programa de tiempo libre remunerado en Canadá incluye feriados, vacaciones, días personales y días por enfermedad, y ofrecemos la gama completa de ausencia laboral reglamentaria. Si se está postulando para este puesto en los EE. UU., póngase en contacto con [e-mail] para obtener más información sobre las disposiciones relativas al tiempo libre remunerado específicas de EE. UU.