Investigation Analyst

locations
- Montreal, Quebec
- Toronto, Ontario
- Kitchener, Ontario
- Waterloo, Ontario
- Halifax, Nova Scotia
- time type
- Temps plein
- posted on
- Publié aujourd'hui
- time left to apply
- Date de fin : 15 octobre 2025 (Il reste 7 jours pour postuler)
- job requisition id
- JR25091965
- Manulife’s 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 digital 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 Investigation Analyst 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 risk management.
- A key focus of the Investigation Analyst is the prevention, detection, and investigation of fraud and abuse related to plan members. This role will proactively identify risk, champion mitigation strategies, conduct plan member and provider investigations and take actions to protect Manulife benefit plans from fraud. 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.

This role reports to the Senior Manager, Fraud Risk Management, and helps to protect plan sponsors and members from the negative impacts of claims fraud. This role is focused on plan member risk mitigation, which is a key part of the foundation for our investigation programs and a vital part of claims risk management.
- Position Responsibilities:
- Perform risk-based data profiling and analysis to identify trends and outliers in various categories for further review and investigation- Lead and support audit programs; coordinating, assessing, and making decisions on investigations- Take initiative and lead investigations to successful conclusion including the preparation of criminal and regulatory complaints- Conduct interviews of plan members, providers of service and others- Create written audits and other correspondence to plan members, providers of service and others- Engages, interacts and consults with various internal contacts such as Customer Service, Legal, Client Relations, Medical Consultants, Regional Group Office and external stakeholders such as Health Practitioner Regulatory Bodies, Colleges and Associations, and Plan Sponsors- Lead, support and implement key investigative projects- Comfortable delivering effective presentations to new and existing clients- Travel may be required for this role including the ability to work outside of core working hours
- Required Qualifications:
- Knowledge of Group Benefits- Knowledge of the Canadian healthcare environment, service delivery model and regulation- University degree or equivalent work experience
- Preferred Qualifications:
- CFE designation is an asset- Knowledge of fraud and abuse risk, and techniques to manage risk- Strong research, problem solving and decision-making skills- Ability to manage contentious interactions with various stakeholders- Excellent oral communication (both phone and face to face) and written communication skills- Intermediate or higher data analysis skills with expertise using Excel and other data mining software- Demonstrate investigation skills with attention to detail- Ability to be creative, critical and aggressive in managing audit and investigative activities- Organizational skills and the ability to manage multiple conflicting priorities
- When you join our team:
- We’ll empower you to learn and grow the career you want.- We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.- As part of our global team, we’ll support you in shaping the future you want to see.
- #LI-HYBRID
- À propos de Manuvie et de John Hancock
- La Société Financière Manuvie est un chef de file mondial des services financiers qui aide les gens à prendre leurs décisions plus facilement et à vivre mieux. Pour en apprendre plus à notre sujet, rendez vous à l’adresse.
- Manuvie est un employeur qui souscrit au principe de l’égalité d’accès à l’emploi
- Chez Manulife/John Hancock nous valorisons notre diversité. Nous nous efforçons d’attirer, de perfectionner et de maintenir une main d'oeuvre qui est aussi diversifiée que nos clients, et de favoriser la création d’un milieu de travail inclusif qui met à profit la diversité de nos employés et les compétences de chacun. Nous nous engageons à assurer un recrutement, une fidélisation, une promotion et une rémunération équitables, et nous administrons toutes nos pratiques et tous