LTC Fraud Investigator

Manulife Insurance Malaysia; Canada; Remote; USD 68,000 - 115,000; Full time

Job summary

Une entreprise dynamique dans le secteur de l'assurance recherche un enquêteur en soins de longue durée pour rejoindre son équipe. Ce rôle passionnant implique d'analyser et d'enquêter sur des activités suspectes liées aux demandes d'indemnisation, en utilisant des techniques avancées d'apprentissage automatique et d'intelligence artificielle. Vous serez un acteur clé dans la détection et la prévention de la fraude, contribuant à des économies significatives pour l'entreprise. Si vous êtes passionné par la justice et que vous souhaitez faire une différence dans le domaine de l'assurance, cette opportunité est faite pour vous.

Benefits

Assurance santé

Assurance dentaire

Congés payés

Plan de retraite

Développement professionnel

Qualifications

• Cinq ans ou plus d'expérience dans un domaine connexe.
• Compétences en communication écrite et verbale efficaces.

Responsibilities

• Mener des enquêtes sur les fraudes et recommander des actions.
• Produire des rapports précis et objectifs sur les cas d'enquête.

Skills

Assurance

Fraude

Analyse des données

Communication écrite

Recherche OSINT

Education

Bachelor en justice criminelle ou domaine connexe

Tools

Excel

Access

PowerPoint

Job description

Locations: É.-U.-Télétravail à temps plein, Manila, Manulife Business Processing Services Canada, Télétravail à temps plein

Time Type: Temps plein

Posted On: Publié il y a 4 jour(s)

Time Left to Apply: Date de fin : 19 octobre 2024 (Il reste 11 jours pour postuler)

Job Requisition ID: JR24041357

The Long-Term Care (LTC) business is on a transformational journey. Being part of this transformation is exciting and offers talented, ambitious people an amazing opportunity to build their JH careers.

We are looking for a candidate with experience in insurance, Medicare, Long-Term Care or Disability fraud with expertise assessing and investigating suspicious activity/behavior during the claim process.

The candidate will be a thought leader identifying and preventing suspicious fraud activity in our US Long-Term Care business using tools, controls and Machine Learning/AI techniques and solutions to detect, capture and proactively prevent fraud, waste & abuse within the LTC claims process. You will partner with all squads to drive savings associated with fraud, waste & abuse. The LTC Investigator will conduct desktop investigations of high complexity related to LTC customers on claim. They will assist and support junior investigators on complex cases. The successful candidate will also provide insights to Data and AI Team on how to evolve data and consider new data sources to drive fraud detection.

Individual Responsibilities:

• Successfully completes investigations with recommendations to internal Global Investigative & Forensic Services team to initiate field investigations and surveillance.
• Detects, investigates and prevents fraud, waste & abuse by agents/brokers, customers, providers, POA and family members.
• Presents case findings to management for review and offers next-step recommendations.
• Gathers and verifies information from systems, proprietary databases and OSINT findings.
• Obtains and reviews physical, documentary, and forensic evidence.
• Produces well-written, accurate, concise, and objective reports.
• Regularly communicates findings and investigation status.
• Completes special projects individually or as a part of an FWA team.
• Maintains knowledge of current investigative techniques, company databases, OSINT, proprietary database resources, and industry trends. Maintains and continuously expands network of professional contacts.
• Assists in the company fraud awareness training programs and annual department training by contributing to development of training materials.
• Performs all duties in strict compliance with department and company guidelines and policies.

What are we looking for:

• Bachelor's degree in criminal justice or related field.
• Experience in insurance, Medicare, Long-Term Care or Disability fraud.
• Law enforcement (financial crimes, FBI) background preferred.
• Five or more years of experience in a related profession.
• Effective written and verbal communication skills.
• Proficient in various computer applications (Excel, Access, PowerPoint).
• Skilled in executing information searches of both the Internet and proprietary databases.
• Ability to apply a working knowledge of state laws and regulations related to insurance fraud and SIU requirements.

What motivates you?

• You obsess about customers, listen, engage and act for their benefit.
• You think big, with curiosity to discover ways to use your agile approach and enable business outcomes.
• You thrive in teams and enjoy getting things done together.
• You take ownership and build solutions, focusing on what matters.
• You do what is right, work with integrity and speak up.
• You share your humanity, helping us build a diverse and inclusive work environment for everyone.

What can we offer you?

• A competitive salary and benefits packages.
• A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.
• A focus on growing your career path with us.
• Flexible work policies and strong work-life balance.
• Professional development and leadership opportunities.

Our commitment to you

• Values-first culture: We lead with our Values every day and bring them to life together.
• Boundless opportunity: We create opportunities to learn and grow at every stage of your career.
• Continuous innovation: We invite you to help redefine the future of financial services.
• Delivering the promise of Diversity, Equity and Inclusion: We foster an inclusive workplace where everyone thrives.
• Championing Corporate Citizenship: We build a business that benefits all stakeholders and has a positive social and environmental impact.

Primary Location: É.-U.-Télétravail à temps plein

Salary range is expected to be between: $68,475.00 USD - $114,125.00 USD

Manulife/John Hancock 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/401(k) savings plans and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in the U.S. includes up to 11 paid holidays, 3 personal days, 150 hours of vacation, and 40 hours of sick time (or more where required by law) each year, and we offer the full range of statutory leaves of absence.