INVESTIGATIVE ANALYST (HYBRID)

Green Shield Canada (GSC); Toronto; Hybrid; CAD 60,000 - 91,000; Full time

Job summary

GreenShield is seeking a seasoned investigator to lead complex audits and fraud investigations within our health benefits programs. You will leverage AI tooling and data analytics to identify patterns, interview providers and plan members, and translate findings into actionable recommendations for leadership and clients.

The role emphasizes independent judgment, cross‑functional collaboration, and the ability to drive preventative fraud strategies while maintaining high standards of ethics,

Qualifications

• 5+ years’ experience in audit and fraud detection.
• Independent judgment in complex investigative scenarios.
• Working knowledge with AI technology.
• Strong analytical and critical-thinking skills.
• Experience contributing to preventative fraud strategies or automation.

Responsibilities

• Support the delivery and evolution of the Claim Watch program, including identification and leading of complex and high‑risk investigations.
• Leverage reporting and AI technology to identify, research, and analyze abuse, misuse, and fraudulent claims activity with a focus on emerging patterns and systemic risk.
• Conduct complex interviews with providers and plan members and exercise independent judgment in ambiguous situations.
• Analyze utilization trends and develop profiling criteria to support fraud controls, using reporting and AI tooling.
• Identify and recommend cost‑containment and risk‑mitigation opportunities, including automation and control enhancements.

Skills

Audit & Fraud Detection

Independent Judgment

AI technology

Analytical Thinking

Leadership

Education

University degree or college diploma in business or related discipline

Tools

Microsoft Office (Access, Excel, Word)

BI / Data Visualization platforms

Job description

WHO WE ARE

GreenShieldis a proudly Canadian, national non-profit health care and insuranceorganization, driven by our mission of Better Health for All.We believe health care is aright, not a privilege, and we are committed to improving health outcomes,advancing health equity, and building a future where every Canadian can reachtheir full health and well-being potential.

Throughour unique integrated payer-provider (\"payvider\") model, we offerinsurance, administer benefits, and pay claims as a ‘payer’ while offeringhealth care services such as mental health, pharmacy, telemedicine, and chronicdisease management as a ‘provider’. As a non-profit social enterprise without shareholders, we reinvest our excessearnings to directly support underserved communities. Through GreenShieldCares, we positively impacted the health and well-being of over one millionCanadians between 2020 and 2025. What’s driving us now is the commitment to measurably impact an additionalthree million Canadians by 2030 – across mental health, essential medicines,and chronic disease management – through scalable initiatives that delivermeaningful change in pursuit of our mission of Better Health for All.

AtGreenShield, our culture is where purpose meets passion and performance. Our teams work as one to delivermeaningful, measurable impact for the people and communities we serve.

THEROLE IN A NUTSHELL

Base Salary: CAD $59,688.00 - 91,109.00

Investigation andAnalysis

• Support the delivery and evolution of the Claim Watch program, including identification and leading of complex and high‑risk investigations.
• Leverage reporting and AI technology to identify, research, and analyze abuse, misuse, and fraudulent claims activity with a focus on emerging patterns and systemic risk.
• Conduct complex interviews with providers and plan members and exercise independent judgment in ambiguous or precedent‑setting situations.
• Analyze utilization trends and develop provider and plan member profiling criteria to support preventative and detective fraud controls, using reporting and AI tooling.
• Identify and recommend cost‑containment and risk‑mitigation opportunities, including automation and control enhancements.
• Develop and implement preventative fraud measures and support audit, compliance, and enterprise risk activities.
• Collaborate across departments and with external stakeholders, including providers, associations, and law enforcement.
• Produce executive-level reporting and analytics that translate complex investigative findings, emerging risks, and fraud trends into actionable business insights and strategic recommendations for leadership and clients.
• Provide mentorship and guidance to investigative staff and contribute to continuous improvement of investigative practices.
• Contribute to and analyze the development of investigative reporting requirements, dashboards, and performance metrics, identifying opportunities to improve visibility into fraud, abuse, misuse, operational effectiveness, and emerging risks.
• Provide trainingand mentoringto peers and team members.
• Support the client/partner specific ClaimWatch governance framework.

WHO WE'RE LOOKING FOR

• Minimum of5years’ experience in audit and fraud detection, health care benefit administration and/or in conducting investigations.
• Demonstrated ability to exercise independent judgment and make defensible decisions in complex investigative scenarios.
• Working knowledge with AI technology.
• Exceptional analytical and critical-thinking skills with demonstrated ability to synthesize large and complex data sets, identify emerging patterns, assess risk, and translate findings into strategic recommendations.
• Experience contributing to preventative fraud strategies, automation, or intelligent audit approaches (asset).
• Demonstrated leadership, mentorship, and ability to influence outcomes across teams without direct authority.
• Demonstrated commitment to continuous learning and professional development, with a strong curiosity for emerging technologies, fraud schemes, industry trends, data analytics, and investigative methodologies.
• University degree or college diploma in business or related discipline required.
• Strong interpersonal skills and the ability to communicate to all levels of internal and external customers both orally and written.
• Understanding of group Health & Dental administration.
• Excellent customer service with a drive todeliver exceptional service.
• Demonstrated capability to meet objectives and milestones when working independently and on project teams.
• Highly organized and able to balance multiple tasks in a fast-paced environment.
• Working knowledge of relevant federal and provincial legislation, regulations and the judiciary system (Including but not limited to: PIPEDA, Regulated Health Professions Act, Privacy Act) would be an asset.
• Proficiency with Microsoft Office tools, including Access, Excel, Word, and other business applications and reporting tools.
• Experience using Business Intelligence (BI) and Data Visualization platforms.
• Ability to travelwithin Canada.

THE CULTURE

We believe a career should be meaningful. Not just ameans to earn a living. Our culture is one where everyone's voice is heard andvalued. Because that’s what it takesto create better health for all. We dare to challenge the status quo. And we’redriven by people who have challenged theirs. We believe that yourworkplace should empower you to be the best version of yourself. That’s why we provide aplace where you can be inspired, challenged, and rewarded.

Where your growth means our growth.

Where your voice is heard and valued.

Where your work has purpose. And purpose matters.

We believe our people arecritical to our overall success. Inclusivity makes us a stronger, smarter andmore informed organization. Being intentionally inclusive of diversebackgrounds, perspectives and experiences will enhance our company culture topositively impact how we support our communities. A career at GreenShield isn’t just about personalachievements, it's about making adifference together.

Here’s to Better Health for All!

AFEW MORE DETAILS

Proficiency in English is requiredfor this position. As part of this role, you will be required to communicatewith colleagues or customers who use English as their primary language. By requiring English proficiency for thisposition, we aim to ensure that our employees can excel in their roles,collaborate, and communicate effectively, and contribute to the success of ourorganization.

GS supports diversity, equity andinclusion in our teams and communities, and we value the unique contributionsmade by all. Even if your experience doesn’t align perfectly to everyrequirement, we invite you to apply. We encourage applications fromall candidates and will accommodate needs under human rights legislationthroughout all stages of the recruitment and selection process. Please let usknow of any accommodation through [e-mail]. Information received relating toaccommodation will be addressed confidentially.

Providing this information givesGS consent to use your personal information to assess your suitability forspecific positions, future opportunities or for your personnel file. Yourrésumé will be held in strict confidence and will be viewed only by theOrganization. Information may be stored outside of Canada and could be used foraggregate statistical purposes (which uses no personal identification).

AI Usage - GreenShield leverages AI to help produce Job Descriptions, and ideate on interview questions. We also leverage AI for interview transcription support.