Bilingual Investigative Review Specialist

Permanent Full Time

We are currently hiring fo a **Bilingual Investigative Review Specialist **- Fraud Management (DPIS), Workplace Solutions with a focus on dental benefits.

Are you a naturally curious problem solver with dental experience? If so, we are seeking an investigator with dental experience to join our high-performance team. This role would be a key member of a team that delivers robust and effective health and dental claims fraud prevention to Canada Life customers.

To be successful in this role, you must possess superior written and verbal communication, problem solving and organization skills to ensure the accurate documentation of the investigation.

This is a hybrid position - the successful applicants will be required to work 3 days a week in office with flexible working hours within our core business hours of 7am-5pm CST.

**What you will do**:

- Conduct thorough case investigations identified through various detection channels
- Understand and interpret data from various sources
- Develop and execute the investigative plan in a timely manner to obtain evidence where fraud or abuse is suspected by contacting (verbal and/or written) appropriate parties, including plan member, claimant and/or provider
- Work closely with other members of the team including investigators, data analysts and the Special Investigations unit
- Accurately document investigative actions and outcomes according to department policy
- Where evidence supports an action, determine and execute the appropriate action according to established protocols
- Create comprehensive reports regarding investigative findings to support criminal, recovery, civil or labour relations actions as needed
- Communicate case information as necessary according to established protocols
- Identify fraud and abuse risks and make recommendations to mitigate future risk
- Collaborate on special projects as assigned including targeted investigations, department process innovations and system enhancements
- Participate in training and mentorship opportunities to other members of the team
- Keep current on industry trends and maintain appropriate professional development

**What you will bring**:

- ** Bilingual in English and French is required**:

- Dental Clinic or Dental industry experience is required
- 2+ years related work experience in an adjudicative, investigative, and/or analytical field or clinic setting
- In-depth knowledge of dental industry practices and procedure including coding and billing processes
- Completion of post-secondary level education (e.g. university or college degree/diploma)
- A combination of relevant experience and education will be considered
- Professional designation in a relevant regulated healthcare field (Dental Hygiene, Dental Assistant) would be considered an asset
- Solution oriented with strong decision-making, problem-solving skills and analytical skills
- Strong customer service mindset
- Excellent communication skills, both verbal and written, in fast-paced and unscripted situations
- Excellent organizational and time management skills; able to manage multiple, simultaneous investigations and re-prioritize as priorities change
- Workplace Solutions Operations knowledge (including legacy systems) would be an asset
- Due to the high profile of a number of our clients, a Federal Government Enhanced Screening is a job requirement which will involve fingerprinting and a credit check. This is a personnel security status that is required before an employee can gain access to Protected B information, assets or work sites as outlined by the Government of Canada website. The cost of submitting these checks will be covered by Canada Life.

**Benefits**:

- Opportunities to carry out challenging work in a dynamic, collaborative and fast-growing team
- Leaders who support your development in a friendly, supportive work environment
- A competitive and comprehensive rewards program including tuition reimbursement, bonuses and flexible benefits
- Paid vacation, personal days and employee volunteer day allotment
- The opportunity to participate in a variety of teambuilding activities and professional development activities that help to strengthen your skills and build strong relationships within the department and company
- Access to various sports leagues such as hockey and indoor soccer, an on-site fitness centre and cafeteria

The base salary for this position is between **$43,800.00 minimum****:

- $65,700.00 maximum** annually. This represents base salary only and does not represent other variable compensation components of our total compensation ( i.e. annual bonus, commission etc). If you are selected to move forward in our recruitment process, your recruiter will be able to discuss additional details of our total rewards program with you.

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