Risk Management Investigator

3 weeks ago

Montreal, Quebec, Canada Manulife Full time
Job Summary:

We are seeking a skilled Risk Management Investigator to join our team. As an investigator, you will play a critical role in preventing, detecting, and investigating fraud and abuse related to our benefit plans.

About the Role:

This is a challenging opportunity for a detail-oriented and analytical individual who can work independently and collaboratively as part of a team. The successful candidate will have excellent communication and problem-solving skills, with the ability to analyze data and identify trends.

Key Responsibilities:
  • Perform risk-based data profiling and analysis to identify trends and outliers
  • Lead and support audit programs, coordinating assessments and making decisions on investigations
  • Take initiative and lead investigations to successful conclusions, preparing criminal and regulatory complaints
  • Conduct interviews with plan members, providers, and other stakeholders
  • Create written audits and correspondence to plan members, providers, and others
  • Engage with internal contacts and external stakeholders, including Health Practitioner Regulatory Bodies, Colleges, and Associations, and Plan Sponsors
  • Lead, support, and implement key investigative projects
Requirements:
  • 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
Preferred Qualifications:
  • Strong research, problem-solving, and decision-making skills
  • Ability to manage contentious interactions with various stakeholders
  • Excellent oral and written communication skills
  • Intermediate 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 ability to manage multiple conflicting priorities
Benefits:

We offer a comprehensive benefits package, including health, dental, mental health, vision, short- and long-term disability, life, and AD&D insurance coverage, adoption/surrogacy benefits, and employee/family assistance plans.

Salary:

The estimated salary for this role is between $61,000 and $73,000 per year, depending on location and experience.

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