Investigative Analyst, Fraud Risk Management

Job Description :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.Using advanced analytics, innovative thinking and investigative excellence, the successful candidate will complete several daily tasks, largely focusing on service provider and collusion schemes involving medical providers and facilities. They will collaborate across teams in the prevention and detection of criminal activity that can threaten the sustainability of group benefit plans. What will you do?Detect and prevent group benefits fraud and abuseTriage tips and referrals related to inappropriate administration practices of service providers, including obtaining witness statementsAction and investigate new leads received through our various fraud prevention programs, Operations and the Call CentreConduct phone interviews with Plan Members, Claimants, Providers and FacilitiesMaintain all databases and logs pertaining to alerts and investigationsProvide support to Investigators by leveraging multiple systems and tools to assist with actively profiling service providersAnalyze plan member and service provider claim submission patterns to identify trendsReview claims and determine eligibilityRespond to inquiries and escalationsPresent findings in a team settingResearch, conduct social media searches, gather data, prepare and organize documentation for plan sponsors, police and managementPromote education and awareness to internal and external stakeholders related to fraud preventionMake recommendations for continuous improvementTimely documentation of investigative steps and outcomesKeep up to date on trends and schemes impacting benefit plansWhat do you need to succeed?Excellent communications skills both verbal and writtenPrevious audit / Investigation experience within Health and Dental Benefits is an assetStrong knowledge of health benefitsKnowledge of medical terminologyNeeds to be able to work independently within a fast-paced work environment and participate in opportunities to share and learn through group collaborationKnowledge and understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industryStrong decision-making and time management skillsAdvanced 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 educationExperience working within audit, investigations, or bankingLaw or accounting backgroundBilingual in English and FrenchReasons why you should join us under the sun:​The opportunity to move along a variety of career paths with amazing networking potentialFlexible Benefits from the day you join to meet the needs of you and your familyA caring, supportive, and inclusive cultureWe are proud to be on the 2024 Best Workplaces in Canada list by Great Place to Work.Must be able to obtain RCMP Reliability Security Clearance before a start date can be confirmed (includes fingerprinting).