Bilingual Investigation Analyst

7 months ago

Montréal, 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 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 online 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.

The Bilingual Investigation Analyst, Analytics, 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 analytics controls. The role will review analytics program outputs to identify trends and key parties requiring investigation and will help facilitate communication between data science teams and business partners to identify and drive effective programs surrounding fraud awareness, detection, and deterrence. 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
- Support analytics programs; coordinating, assessing, and making decisions on the need for further investigations
- Assist as needed with the development of new tools and metrics, analytics programs and collaborations with data science partners and external data vendors.
- Take action on analytics program results, enhancing risk profile assessments, setting investigation framework resulting from the alerts, dialoguing with professional associations and regulatory colleges, industry peers and vendors, and collaborating/consulting on downstream investigations as needed
- Understand and maintain current knowledge of audit and investigative techniques, tools, software, and technology
- Support French speaking investigation work and case management where needed

**How will you create impact?**

This role reports to the Program Manager, Investigation Services, and helps to protect plan sponsors and members from the negative impacts of claims fraud. This role is focused on risk detection, which is the foundation for our investigation programs and a vital part of claims risk management.

A key function of the Investigation Analyst, Analytics role is reviewing analytics leads for claims of interest from all submission channels. This role will proactively identify high risk trends, champion detection strategies, assess effectiveness of analytics outputs and take actions to improve our ability to protect Manulife benefit plans from fraud and abuse.

**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
- Strong data analysis skills with expertise using Excel and other data mining software
- Knowledge of PowerBI, Tableau, PowerApps, and/or SQL an asset.
- Demonstrated investigation skills with attention to detail
- 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
- Understanding of provider regulatory colleges and professional associations
- Demonstrated strong analytical and problem-solving skills
- Ability to assess analytics programs for effectiveness and make recommendations for enhancements in an evolving environment
- Skills and ability to analyze and organize data to support analysis and recommendations for efficiencies in case triage and review processes
- Exceptional time management and organizational skills. Ability to manage multiple conflicting priorities in a fast-paced changing environment is essential.

**What can we offer

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