Investigation Analyst

1 week ago

Waterloo, Canada Manulife Full time

Manulife's Group Benefits Health and Dental Claims Risk Management team focuses on digital claims risk management, fraud investigations, and data analytics to support key operational objectives. The Investigation Analyst - Provider Risk plays a crucial role in preventing, detecting, and investigating fraud and abuse among healthcare providers, implementing risk mitigation strategies to protect benefit plans.

This position involves collaboration with internal departments and external contacts, reporting to the Senior Manager, Fraud Risk Management, and is key to safeguarding plan sponsors and members from claims fraud. If you have an investigative spirit and strong analytical skills in the Canadian Health Care Industry, this role might be for you.

**Position Responsibilities**:

- **Data Analysis and Investigation**: Perform risk-based data profiling to identify trends and outliers, leading investigations to successful conclusions, including preparing criminal and regulatory complaints.
- **Audit Leadership**: Lead and support audit programs by coordinating, assessing, and making decisions on investigations, and conducting interviews with plan members and service providers.
- **Communication and Reporting**: Create written audits and correspondence for plan members and service providers, while engaging with internal and external stakeholders to ensure comprehensive investigation processes.

**Required Qualifications**:

- 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 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
- Demonstrated 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**

**About Manulife and John Hancock**

**Manulife is an Equal Opportunity Employer**

**Primary Location**

Waterloo, Ontario

**Working Arrangement**

Hybrid
**Salary range is expected to be between**

$42,825.00 CAD - $71,375.00 CAD

Manulife offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short

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