Bilingual Investigator, Fraud Risk Management

2 months ago

Montréal QC HT B, Canada Sun Life Full time

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

**Location**: hybrid

Fraud management is increasingly important to policyholders. In order to serve Sun Life’s clients as industry leaders, the Canadian Operations’ Fraud Risk Management area will identify, mitigate and respond to criminal threats using various tools, technologies and strategies.

Reporting to the Fraud Risk Management Manager, the Investigator will investigate situations involving possible dishonest, fraudulent, and/or abusive activities related to Group Benefits claims, with a focus on Disability files. Responsibilities include assessing identified leads, plan sponsors, service providers, and attending physicians, reporting findings to Compliance & Governance and Group Benefit Disability representatives, possibly presenting evidence to police and regulatory bodies, training and consulting, and supporting presentations regarding the Disability Claims Disability Investigation Program.

**What will you do?**
- Conduct a formal inquiry when fraudulent Disability claims, or related dishonest activity is suspected
- Conduct interviews and take statements from plan members, plan sponsors, service providers, attending physicians, and other third parties
- Prepare and file regulatory complaints and police case referrals
- Contribute to the ongoing evolvement of the Disability Claims Disability Investigations Program
- Assist in coordinating efforts between FRM and Disability Claims to identify and investigate claims fraud and plan abuse
- Provide investigative expertise and related reporting on cases to FRM management, the Ombudsman, Disability Claims, Business Development, Customer Care Centre, and other pertinent internal and external stakeholders
- Collect and safeguard investigation evidence
- Maintain all databases and logs pertaining to investigations
- Identify fraud trends and support data analytics solutions to mitigate the newly identified risk
- Remain current and up to date on industry trends/education/products/privacy laws/etc.
- Assist in training and educating internal and external stakeholders on FRM’s Disability Claims Investigation fraud processes

**What do you need to succeed?**
- Bilingualism (French, English, both oral and written) is required to answer calls from English and French speaking clients across Canada and worldwide
- Exceptional communications skills both verbal and written
- Experience in Disability claims, including supporting case management decisions
- Strong knowledge of Group Benefits products, with extensive knowledge of Short and Long Term Disability offerings
- Experience in open source searching and analyzing online information
- Previous audit / investigation experience within the insurance industry, preferably within Group Benefits Claims
- Knowledge of medical terminology
- Experience performing interviews
- Strong analytical skills, especially analyzing data to drive decisions and/or actions
- Demonstrated success as an individual contributor who can also effectively collaborate within a team
- Knowledge and understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry
- Strong decision-making skills
- Excellent PC skills (Word, Excel, Power Point, Access)

**Reliability Status**
- Must be able to obtain Reliability Status through the Government of Canada (includes a background check with fingerprinting by the RCMP).

**Reasons why should you join us under the sun**
- A caring, supportive, and inclusive culture
- The opportunity to move along a variety of career paths with amazing networking potential
- Care Days available for self-care or care of others (i.e., family or others you may support) and Sick Days to support your well-being.
- Flexible Benefits from the day you join to meet the needs of you and your family
- Pension Plan participation starts immediately, and you are automatically enrolled. We help you save more with Sun Life automatic and matching contributions and by including both your salary and bonus when making contributions

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

We thank all applicants for showing an interest in this position. Only those selected f

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