Investigative Analyst, Fraud Risk Management

4 days ago

Montréal, 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.

Fraud management is increasingly important to policyholders. To serve Sun Life’s clients as industry leaders, Canadian Operations’ Fraud Risk Management area will identify, mitigate and respond to criminal threats using various tools, technologies and strategies. Reporting to the Manager for Fraud Risk Management, the Investigative Analyst will work in partnership with Investigators in the identification and investigation of situations involving suspected dishonest and fraudulent claiming activities pertaining to medical service providers and plan members.

**What will you do**:

- Detect and prevent group benefits fraud and abuse
- Triage tips and referrals related to inappropriate administration practices of service providers, including obtaining witness statements
- Provide support to Investigators by leveraging multiple systems and tools to assist with actively profiling service providers
- Analyze plan member and service provider claim submission patterns to identify trends
- Review claims and determine eligibility
- Respond to inquiries and escalations
- Present findings in a team setting
- Research, conduct social media searches, gather data, prepare and organize documentation for plan sponsors, police and management
- Promote education and awareness to internal and external stakeholders related to fraud prevention
- Make recommendations for continuous improvement
- Timely documentation of investigative steps and outcomes
- Keep up to date on trends and schemes impacting benefit plans

**What you need to succeed**:

- Excellent communications skills both verbal and written
- Previous audit / investigation experience
- Strong knowledge of health benefits
- Knowledge of medical terminology
- Needs to be able to work independently within a fast-paced work environment and participate in opportunities to share and learn through group collaboration
- Knowledge and understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry
- Strong decision-making and time management skills
- Advanced computer skills (Word, Excel, Tableau, Outlook)
- As this position is posted in several locations, we specify that bilingualism (French, English, both oral and written) is required for Quebec only for the frequent interactions with English and French-speaking colleagues or internal partners across Canada or worldwide.

**Assets**:

- University degree or postsecondary education
- Experience working within audit, investigations, or banking
- Law or accounting background

**What’s in it for you?**
- We’re proud to be recognized as a company with a 2023 Most Trusted Executive team by Great Place to Work® Canada
- Access to short-term assignments or ‘Gigs’ across the organization, to help you develop new skills and connections.
- A collaborative and interactive team environment
- Charitable giving through our You Give, We Give program lets you give back to your community - and in many cases, we’ll match your contributions.
- 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.

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 for an interview will be contacted.

**Salary Range**:
43,200/43 200 - 70,800/70 800

**Job Category**:
Risk Management

**Posting End Date**:
16/04/2024

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