Investigative Analyst, Bilingual

2 weeks ago

Montréal QC, Canada Green Shield Full time

**WHO WE ARE**
When it comes to health, we’re always looking for ways to push for better. It’s why we were founded in the first place. In 1957, our founder, pharmacist William Wilkinson, witnessed a mother sacrifice her health by forgoing her own medicine to pay for her sick daughter’s prescription. He knew there had to be a better way. So, he introduced North America’s first prepaid drug plan, and GreenShield was born as a not-for-profit with a mission to support better health for all Canadians.

We aren’t just a health and benefits company. We’re the only not-for-profit social enterprise that brings worlds of coverage and care together, all in one place.
We’re noble challengers, purposefully building a better way and we need the best people to help us create a more holistic approach that takes care of the mind and body.

Our mission is to create better health for all Canadians, and we know that starts with our employees.

**THE ROLE IN A NUTSHELL**
This role reports to the Supervisor, Claim Watch.
- Identify, research, and analyze areas of abuse, misuse and fraudulent claims activity from Providers and Plan Members specific to our Extended Health Care Benefits
- Conduct interviews and act as an undercover agent (mystery shopper).
- Communicating regularly with plan sponsors and other partners
- Research trends in health benefit utilization
- Develop provider and plan member profiling criteria
- Identify and make recommendations on cost containment opportunities
- Develop and implement preventative fraud measures
- Work directly with all departments of the organization, various medical providers and associations, law enforcement, etc. to achieve objectives of the Claim Watch Team
- Build summary reports of findings and present conclusions and recommendations as required

**WHO WE'RE LOOKING FOR**

**WHO WE'RE LOOKING FOR**
- Minimum of 3 years’ experience in audit and fraud detection, health care benefit administration, pharmaceutical field and/or conducting investigations
- A university degree or diploma in a related discipline or equivalent work experience.
- Established analytical, complex problem solving, and decision-making skills
- Demonstrated ability to analyze legislation and policies
- Working knowledge of relevant federal and provincial legislation, regulations and the judiciary system (Including but not limited to: PIPEDA, Regulated Health Professions Act, Privacy Act) would be an asset
- Strong computer skills, with an ability to develop and craft reports including validation of these reports.
- Extraordinary consultation and negotiation skills
- Strong interpersonal skills and the ability to communicate to all levels of internal and external customers both orally and written
- Able to work in an independent work environment as well as in a team
- Strong attention to detail and organizational skills
- Bilingualism (English and French)

**NICE TO HAVE**
- Private Investigator license, issued by the appropriate body
- A Certified Fraud Examiner (CFE) certificate.
- A Certified Anti-Money Laundering Specialist (CAMS) certificate

Applications will be received until 7 p.m. EST, Monday, December 16, 2024.

**THE CULTURE**
We believe a career should be meaningful. Not just a means to earn a living. Our culture is one where everyone's voice is heard and valued. Because that’s what it takes to create better health for all. We dare to challenge the status quo. And we’re driven by people who have challenged theirs. We believe that your workplace should empower you to be the best version of yourself. That’s why we provide a place where you can be inspired, challenged, and rewarded.

Where your growth means our growth.
Where your voice is heard and valued.
Where your work has purpose. And purpose matters.

We believe our people are critical to our overall success. Inclusivity makes us a stronger, smarter and more informed organization. Being intentionally inclusive of diverse backgrounds, perspectives and experiences will enhance our company culture to positively impact how we support our communities. A career at GreenShield isn’t just about personal achievements, it's about making a difference together.

Here’s to Better Health for All

**A FEW MORE DETAILS**
Proficiency in English is required for this position. As part of this role, you will be required to communicate with colleagues or customers who use English as their primary language. By requiring English proficiency for this position, we aim to ensure that our employees can excel in their roles, collaborate, and communicate effectively, and contribute to the success of our organization.

Providing this information gives GS consent to use your personal information to assess your suitability for specific positions, future opportunities or for your personnel file. Your résumé will be held in strict confidence and will be viewed only by the Organization. Information may be stored outside of Canada and could be used for aggr

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