TD Insurance, Senior Investigator

Meloche Monnex Inc.; Montreal; On-site; CAD 70,000 - 90,000; Full time

Job summary

A leading insurance provider in Montreal is seeking a Senior Investigator to lead investigations into suspected insurance fraud. You will gather and analyze evidence, ensuring compliance with legal standards while maintaining confidentiality. The ideal candidate has over 5 years of claims handling experience, is detail-oriented, and is bilingual in English and French. This role offers a comprehensive benefits package and opportunities for career development.

Benefits

Health and well-being benefits

Retirement programs

Career development opportunities

Paid time off

Qualifications

• 5+ years of claims handling experience.
• Demonstrated commitment to fraud investigation.
• Precision and attention to detail in analyses.
• Ability to handle difficult conversations tactfully.

Responsibilities

• Lead comprehensive investigations into suspected fraud.
• Gather and analyze evidence in compliance with legal standards.
• Communicate investigation outcomes to stakeholders.
• Maintain confidentiality and comply with privacy laws.

Skills

Claims handling experience

Critical thinking

Attention to detail

Active listening

Bilingualism in English and French

Education

AMF issued Claims Adjusting License

CIP program enrolment

Job description

Senior Investigator – TD Insurance

The Senior Investigator will identify, investigate, and mitigate instances of suspected insurance fraud to protect the organization from financial losses while ensuring compliance with regulatory and legal standards. This role involves leading comprehensive investigations into complex fraud cases, gathering and analyzing evidence, and collaborating with internal teams and external entities such as law enforcement and regulatory agencies.

Key Accountabilities

• Make recommendations for enhancements that will create or enhance fraud detection techniques that mitigate exposure without sacrificing customer experience.
• Conduct comprehensive investigations into suspected fraudulent claims to protect the organization and ensure fairness to all customers, including those filing legitimate claims.
• Collect, analyze, and preserve evidence in compliance with legal standards, ensuring all findings support accurate claim resolutions.
• Maintain focus on minimizing fraudulent activities without causing undue delays or burdens on legitimate claimants.
• Communicate investigation outcomes clearly and professionally to internal and external customers, such as claimants, policyholders, and legal representatives.
• Provide updates to claimants and relevant stakeholders during investigations, ensuring transparency and alignment with customer service standards.
• Act as a steward of trust by identifying and addressing fraudulent activity that could compromise the integrity of the claims process, thereby safeguarding the interests of honest customers.
• Ensure compliance with legal, regulatory, and ethical standards in all investigative actions to protect the organization’s reputation and maintain customer confidence.
• Prioritize timely investigations to ensure legitimate claims are resolved quickly and efficiently without unnecessary delays for policyholders.
• Balance investigative thoroughness with service excellence to achieve outcomes that are fair and just for all customers.
• Handle all customer and claim information with the utmost confidentiality and in compliance with privacy laws and organizational policies.
• Safeguard sensitive information to protect customers from further harm or risk associated with fraud.

Shareholder Responsibilities

• Prioritize and manage own workload to meet SLA requirements for service and productivity.
• Consistently exercise discretion in managing correspondence, information and all matters of confidentiality; escalate issues where appropriate.
• Be knowledgeable of practices and procedures within own area of responsibility and keep abreast of emerging trends for own functional area.
• Understand and apply operating policies and procedures.
• Follow internal and industry regulations and operating practices in completing and recording transactions for either the organization or clients.
• Ensure documentation that is prepared / completed is accurate and properly reflects business intentions and is consistent with relevant rules / regulations.
• May lead work streams by acting as a project lead / subject matter expert for small scale projects / initiatives in accordance with project management methodologies.
• Complete investigations – report / elevate risk issues or process gaps identified.
• Identify and recommend opportunities to enhance productivity, effectiveness and operational efficiency.
• Ensure necessary due diligence to support the accuracy of all transactions / activities.
• Maintain a culture of risk management and control, supported by effective processes in alignment with risk appetite.
• Be knowledgeable of and comply with Bank Code of Conduct.

Employee / Team Contributions

• Participate fully as a member of the team, support a positive work environment that promotes service to the business, quality, innovation and teamwork and ensure timely communication of issues / points of interest.
• Support the team by continuously enhancing knowledge / expertise in own area and participate in knowledge transfer within the team and business unit.
• Keep current on emerging trends / developments and grow knowledge of the business, related tools and techniques.
• Participate in personal performance management and development activities, including cross training within own team.
• Keep others informed and up-to-date about the status / progress of projects and / or all relevant or useful information related to day‑to‑day activities.
• Contribute to the success of the team by willingly assisting others in the completion and performance of work activities; provide training, coaching and / or guidance as appropriate.
• Contribute to a fair, positive and equitable environment that supports a diverse workforce.
• Act as a brand champion for your business area / function and the bank, both internally and / or externally.

Breadth & Depth

• Serves as a subject matter expert in operational function and performs end to end activities, may serve as knowledge and process expert to others.
• Requires advanced understanding of a range of product and services, processes, procedures, systems and concepts within their own area of specialty and integration points with related areas.
• Applies advances knowledge of business drivers, processes, and customers to coordinate with other related areas to improve efficiency and deliver results.
• Manages ambiguity, and applies judgement to identify, troubleshoot and resolve ongoing business and operational issues.
• Interprets and administers policies, adopts and implements business process improvements.
• Impacts the quality, efficiency and ongoing operations of one or multiple units.
• May represent as a project lead on projects / initiatives and / or at meetings across the organization.
• Reports to a Group Manager.

Job Requirements

• 5+ years of claims handling experience (additional consideration will be given to those with significant expertise in multiple lines of business).
• Innate curiosity with a demonstrated ability to apply critical questioning & thinking.
• A demonstrated commitment to fraud investigation through previous SIU referrals / involvement.
• Precision and attention to detail.
• Practiced in active listening and summarizing evidence and analytical assessments in order to provide solid and supportable conclusions / actions.
• Expert knowledge of Insurance products, systems, policies and procedures and Insurance Act and associated legislation.
• Ability to professionally and tactfully handle difficult conversations and confrontation.
• Enrolment in the CIP program and completion of the Principles & Practices course is an asset.
• Autonomous time management is critical.
• Bilingualism in English and French is a requirement.
• An AMF issued Claims Adjusting License is required in order to be considered for the role.

Who We Are – TD Insurance

Td Bank Group is one of Canada’s largest financial institutions. At TD Insurance, we care for Canadian families, making it easy to get the best advice, protection, and support in their moments of need. TD Insurance offers a wide range of products, including General Insurance and Life and Health. More than four million customers count on us as the largest direct-to‑consumer insurer in Canada, consistently innovating and providing rewarding career opportunities across Canada.

Benefits & Total Rewards

Our Total Rewards package reflects the investments we make in our colleagues to help them and their families achieve financial, physical and mental well‑being goals. It includes a base salary, variable compensation, health and well‑being benefits, retirement programs, paid time off, career development and recognition programs, and other key plans.