Investigation Analyst

The Group Benefits Health and Dental Claims Risk Management department is a diverse and dynamic team delivering a broad range of services in support of key operational objectives. Our responsibilities include online claims risk management, claims abuse management and monitoring programs, fraud investigations, data analytics, and claims experience management. Effective management of health and dental claims experience is imperative to the success of group benefits operations. The Investigation Analyst, Analytics, will draw on their in-depth analytical skills, investigative mindset, customer focus, group benefits background and understanding of the Canadian Healthcare environment/regulation to help manage ongoing priorities in the delivery of analytics controls. The role will review analytics program outputs to identify trends and key parties requiring investigation and will help facilitate communication between data science teams and business partners to identify and drive effective programs surrounding fraud awareness, detection, and deterrence. The role may liaise externally with industry contacts and vendors, and internally with Legal, Compliance, Advanced Analytics, Marketing, Customer Service, Client Relations, Ombudsman and the Field as needed. This role reports to the Program Manager, Investigation Services, and helps to protect plan sponsors and members from the negative impacts of claims fraud. This role is focused on risk detection, which is the foundation for our investigation programs and a vital part of claims risk management. A key function of the Investigation Analyst, Analytics role is reviewing analytics leads for claims of interest from all submission channels. This role will proactively identify high risk trends, champion detection strategies, assess effectiveness of analytics outputs and take actions to improve our ability to protect Manulife benefit plans from fraud and abuse. Position Responsibilities Support investigation work and case management where needed Perform risk-based data profiling and analysis to identify trends and outliers in various categories for further review and investigation Support analytics programs; coordinating, assessing, and making decisions on the need for further investigations Assist as needed with the development of new tools and metrics, analytics programs and collaborations with data science partners and external data vendors. Take action on analytics program results, enhance risk profile assessments, setting investigation framework resulting from the alerts, dialoguing with professional associations and regulatory colleges, industry peers and vendors, and collaborating/consulting on downstream investigations as needed Understand and maintain current knowledge of audit and investigative techniques, tools, software, and technology Required Qualifications University degree or equivalent work experience Strong data analysis skills with expertise using Excel and other data mining software Knowledge of Group Benefits Preferred Qualifications Strong data analysis skills with expertise using Excel and other data mining software Knowledge of PowerBI, Tableau, PowerApps, and/or SQL, an asset. Demonstrate investigation skills with attention to detail CFE designation is an asset Knowledge of fraud and abuse risk, and techniques to manage risk Strong research, problem solving and decision-making skills Understanding of provider regulatory colleges and professional associations Demonstrated strong analytical and problem-solving skills Ability to assess analytics programs for effectiveness and make recommendations for enhancements in an evolving environment Ability to apply critical thinking in the assessment, ranking, and solving complex data reviews and leads Skills and ability to analyze and organize data to support analysis and recommendations for efficiencies in case triage and review processes Exceptional time management and organizational skills. Ability to manage multiple conflicting priorities in a fast-paced changing environment is essential. 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. #LI-HYBRID マニュライフとジョン・ハンコックについて マニュライフ・ファイナンシャル・コーポレーションは、「あなたの未来に、わかりやすさを」を提供する、国際的な大手金融サービスプロバイダーです。当社について詳しくは、 https://www.manulife.co.jp/をご覧ください。 マニュライフは機会均等を是とする雇用主です マニュライフ/ジョン・ハンコックでは、多様性を受け入れます。私たちは、サービス提供先であるお客さまと同様に、多様な人材を引きつけ、育成し、定着させ、文化や個人の力を受け入れる包括的な職場環境を促進するよう努めています。当社は公正な採用、定着、昇進、報酬に努めています。当社のすべての慣行およびプログラムは、人種、祖先、出身地、肌の色、民族的出自、市民権、宗教または宗教的信念、信条、性別（妊娠および妊娠関連の状態を含む）、性的指向、遺伝的特徴、退役軍人としての地位、性自認、性に関する表明、年齢、婚姻状況、家族状況、障害、または適用法で保護されるその他の要因に対する一切の差別を行うことなく管理されます。 雇用への平等なアクセスを提供するために、障壁を取り除くことが当社の優先事項です。人事担当者は、応募者が応募プロセス中に合理的配慮を要求する場合に協力します。配慮要求のプロセス中に共有されるすべての情報は、適用される法律およびマニュライフ/ジョン・ハンコックのポリシーに準拠した方法で保存および使用されます。申請プロセスにおいて合理的配慮を要求するには、recruitment@manulife.comまでご連絡をお願いします。 Referenced Salary Location Waterloo, Ontario Working Arrangement ハイブリッド勤務 Salary range is expected to be between $42,825.00 CAD - $71,375.00 CAD If you are applying for this role outside of the primary location, please contact recruitment@manulife.com for the salary range for your location. The actual salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education/training. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance. Manulife 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 and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in Canada includes holidays, vacation, personal, and sick days, and we offer the full range of statutory leaves of absence. If you are applying for this role in the U.S., please contact recruitment@manulife.com for more information about U.S.-specific paid time off provisions. #J-18808-Ljbffr