Bilingual Investigation Analyst

6 months ago

Waterloo, Canada Manulife Full time

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 Bilingual Investigation Analyst, Provider Risk is in the prevention, detection, and investigation of fraud and abuse specific to health care providers. This role will proactively identify risk, champion mitigation strategies, conduct provider investigations and take actions to protect Manulife benefit plans from fraud. This role contributes to our claims experience management and the success of our overall Fraud Prevention Program.

**Responsibilities**
- Strong knowledge of Group Benefits
- Certified Fraud Examiner (CFE) designation is an asset
- Knowledge of the Canadian healthcare environment, service delivery model and regulation
- University degree or equivalent work experience
- Strong knowledge of fraud and abuse risk, and techniques to manage risk
- Strong research, problem-solving and decision-making skills
- Ability to manage contentious interactions with various stakeholders
- Excellent oral communication (both phone and face-to-face) and written communication skills in both English and French
- Advanced data analysis skills with expertise using Excel and other data mining software
- Skills and ability to analyze and organize data to support analysis and recommendations
- Demonstrated investigation skills with attention to detail
- Advanced interviewing skills
- Ability to coach and mentor more junior staff, acting as question support within connected departments and teams
- Good knowledge of compliance issues governing group benefits, provincial laws and regulations governing insurance, privacy and the criminal and legal framework
- Understanding of emerging threats, associated risks and impact on benefit plans
- Exceptional time management and organizational skills. The ability to manage multiple conflicting priorities in a fast-paced changing environment is essential.

**How will you create impact?**

The Bilingual Investigation Analyst, Provider Risk will draw on their analytical skills, investigative expertise, customer focus, Group Benefits background, understanding of the Canadian Healthcare environment, regulation, and legislation to determine the ongoing priorities in the delivery of provider controls.

This role will investigate providers and identify those with inappropriate and/or fraudulent business practices taking actions including putting forth recommendations in handling including delisting specific providers from payment across our block. The Bilingual Investigation Analyst must be highly skilled in decision making and negotiating as this role will be regularly confronted with potentially contentious situations requiring immediate and appropriate responses.

This role must be a confident communicator with an investigative background, have a technical aptitude with experience using analytical tools, demonstrate leadership skills to provide mentoring to more junior roles and understand the regulatory and legislative environment across the country in particular as it relates to healthcare and privacy.

This role reports to the Director, Fraud & Investigation, and helps to protect plan sponsors and members from the negative impacts of claims fraud. This role is focused on provider risk mitigation, which is a key part of the foundation for our investigation programs and a vital part of claims risk management.

A key function of the Bilingual Investigation Analyst, Provider Risk role is the investigation of service providers, coaching of more junior staff through question support and guidance, representation of the overall program to management, and providing support for reporting and KPIs on an ongoing basis.

**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.
- Yo

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