Program Manager, Investigation Services
6 months ago
We are a leading financial services provider committed to making decisions easier and lives better for our customers and colleagues around the world. From our environmental initiatives to our community investments, we lead with values throughout our business. To help us stand out, we help you step up, because when colleagues are healthy, respected and meaningfully challenged, we all thrive. Discover how you can grow your career, make impact and drive real change with our Winning Team today.
**Working Arrangement**
Hybrid
The Risk Management Department is a diverse and dynamic team delivering a broad range of services in support of key operational objectives. Our responsibilities include Digital Claims Risk Management, Abuse Management and Monitoring Programs, Fraud Investigations, Technical Support, Analytics, and Claims Experience Management. The effective management of Health and Dental claims experience is imperative to the success of the Group Benefits Operations.
A key focus of the Program Manager, Investigation Services is accountability for managing fraud and abuse for our Drug and Dental benefits and innovating relative programs to match future needs.
**Responsibilities**
- Lead teams of anti-fraud professionals to prevent, detect, investigate and deter fraud and abuse
- Create high performance teams by providing staff with continuous development and mentoring, and opportunities for them to build on their investigation capabilities
- Develop and deliver anti-fraud programs in compliance with Manulife’s Fraud policy, regulators’ expectations (e.g. OSFI), client expectations and commitments, and compliance and legislative requirements (e.g. SOX)
- Manage investigation service levels and prioritizes dental and drug program tips and alerts and lead the development of investigation and communication plans for dialogue and negotiation with service providers
- Monitor and build on analytical controls for effective identification of actionable cases and identify weaknesses and gaps to close for ongoing effective fraud risk management
- Identify new and emerging risks to Group Benefits and Affinity business lines and drive requirements (e.g. fraud analytics and tools) and tactics to proactively address and mitigate financial and reputational risks thereby minimizing negative impact to Manulife, our customers, and shareholders
- Influence or direct appropriate actions on fraud cases including pursuing recovery of payments, regulatory complaints, criminal complaints, civil actions and client communications, through employing a strong understanding of the criminal, civil, legal, and compliance/privacy framework and considering customer expectations
- Provide leadership on complex, escalated cases involving significant legal, privacy, and reputational risk and ensure that proper legal and compliance advice is sought, that appropriate senior management is kept informed, and that appropriate decisions are made.
- Provide Group Benefits with expert fraud risk advice related to new products and services, product changes, legislative changes and emerging fraud schemes.
- Promote fraud awareness externally with our Plan Sponsors, Advisors, and Consultants, and internally through the development and delivery of awareness modules to internal Group Benefits and Affinity staff.
- Lead client meetings addressing sensitive audit and investigations with Plan Sponsors and support client requests through our Regional Group Offices and Customer Service Centres
- Deliver presentations to existing clients. Respond and present to prospective clients through the Request for Proposal (RFP) process
- Manage expenses within the approved budget
- Monitor financial results of investigation programs
- Pursue opportunities to create efficiencies within programs
- Lead the continued development of the investigative model to manage high-risk providers and suspicious transactions and support analytics staff with the continuous development and enhancement of Fraud Data Analytics addressing existing, new, and emerging risk
- Perform risk assessments, develop risk-mitigating strategies and deliver controls to protect the benefits investment of our clients
- Understand and maintain current knowledge of audit and investigative techniques, tools, software and technology
- Work with key stakeholders including dental and pharmaceutical provider associations and colleges, government bodies and law enforcement; developing and strengthening relationships to influence change, collaborating on shared issues to develop solutions, and identifying and developing ongoing information and education for consumers, stakeholders and industry members
- Assist in protecting and preserving Group Benefits market place competitive advantages through ongoing enhancement of fraud prevention program activities
- Lead or participate in industry anti-fraud and related working groups representing the interests of both our customers and shareholders with the goal of
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