Investigation Analyst

7 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

Manulife’s 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 digital claims risk management, claims abuse management and monitoring programs, fraud investigations, data 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 Investigation Analyst is the prevention, detection, and investigation of fraud and abuse specific to healthcare providers. This role will proactively identify risk, champion mitigation strategies, conduct provider investigations and take actions to protect Manulife benefit plans from fraud. 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.

**Responsibilities**
- Perform risk-based data profiling and analysis to identify trends and outliers in various categories for further review and investigation
- Lead and support audit programs; coordinating, assessing, and making decisions on investigations
- Take initiative and lead investigations to successful conclusion including the preparation of criminal and regulatory complaints
- Conduct interviews of plan members, providers of service and others
- Create written audits and other correspondence to plan members, providers of service and others
- Engages, interacts and consults with various internal contacts such as Customer Service, Legal, Client Relations, Medical Consultants, Regional Group Office and external stakeholders such as Health Practitioner Regulatory Bodies, Colleges and Associations, and Plan Sponsors
- Lead, support and implement key investigative projects
- Comfortable delivering effective presentations to new and existing clients
- Travel may be required for this role including the ability to work outside of core working hours

**How will you create impact?**

Do you have an investigative spirit and want to push your analytical skills and knowledge of the Canadian Health Care Industry to the next level? If so, Manulife’s Investigation Analyst, Health and Dental Claims Risk Management position might be for you.

This role reports to the Senior Manager, Fraud Risk Management, 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.

The Investigation Analyst 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 risk management.

**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.
- You share your humanity, helping us build a diverse and inclusive work environment for everyone

**What we are looking for**
- Knowledge of Group Benefits
- Knowledge of the Canadian healthcare environment, service delivery model and regulation
- University degree or equivalent work experience
- CFE designation is an asset
- 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
- Intermediate or higher data analysis skills with expertise using Excel and other data mining software
- Demonstrated investigation skills with attention to detail
- Ability to be creative, critical and aggressive in managing audit and investigative activities
- Organizational skills and the ability to manage multiple conflicting priorities

**What can we offer you?**
- A competitive salary and benefits package.
- A growth trajectory that extends upward and outward, encouraging

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