Compliance Risk Investigator

2 weeks ago

Montreal, Quebec, Canada undisclosed Full time

Role Summary

Undisclosed is seeking a highly skilled Bilingual Compliance Investigator to join its team in Risk Management. The ideal candidate will have a strong background in investigating situations involving possible dishonest, fraudulent, and/or abusive activities related to Group Benefits claims, with a focus on Disability files.

Key Responsibilities

  • Conduct formal inquiries when fraudulent Disability claims or related dishonest activity is suspected
  • Conduct interviews with plan members, plan sponsors, service providers, and other third parties
  • Prepare and file regulatory complaints and police case referrals
  • Contribute to the ongoing evolution of the Disability Claims Disability Investigations Program
  • Assist in coordinating efforts between Fraud Risk Management and Disability Claims to identify and investigate claims fraud and plan abuse
  • Provide investigative expertise and related reporting on cases to management, the Ombudsman, Disability Claims, Business Development, Customer Care Centre, and other pertinent stakeholders
  • Collect and safeguard investigation evidence
  • Maintain all databases and logs pertaining to investigations
  • Identify fraud trends and support data analytics solutions to mitigate newly identified risks
  • Remain current and up-to-date on industry trends, education, products, and privacy laws
  • Assist in training and educating internal and external stakeholders on Fraud Risk Management's Disability Claims Investigation fraud processes

Requirements

  • Bilingualism (French and English, both oral and written) is required to answer calls from English and French-speaking clients across Canada and worldwide
  • Exceptional communication skills, both verbal and written
  • Experience in Disability claims, including supporting case management decisions
  • Strong knowledge of Group Benefits products, with extensive knowledge of Short and Long Term Disability offerings
  • Experience in open-source searching and analyzing online information
  • Previous audit/investigation experience within the insurance industry, preferably within Group Benefits Claims
  • Knowledge of medical terminology
  • Experience performing interviews
  • Strong analytical skills, especially analyzing data to drive decisions and/or actions
  • Demonstrated success as an individual contributor who can also effectively collaborate within a team
  • Knowledge and understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry
  • Strong decision-making skills
  • Excellent PC skills (Word, Excel, PowerPoint, Access)

Reliability Status

  • Must be able to obtain Reliability Status through the Government of Canada, including a background check with fingerprinting by the RCMP

Salary Range: 54,000 - 91,000

Job Category: Risk Management

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