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Bilingual Dental Investigator

2 weeks ago

Montréal, Canada Sun Life Full time

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

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.

Investigations require regular contact with external stakeholders including plan members, dental providers, associations, and colleges. The Investigator will be required to present findings, file regulatory complaints, prepare police cases, and give evidence at regulatory, civil and/or judicial hearings.

**What will you do?**
- Identify high-risk areas of fraud and abuse in the dental landscape and make recommendations to address control gaps and continuous improvement.
- Investigate situations of fraud and/or abuse with a focus on dental providers, clinics, and plan members.
- Identify trends, report on issues and suggest appropriate actions to internal and external stakeholders.
- Identify and partner in the development and implementation of processes for handling investigations.
- Conduct plan member and provider interviews.
- Perform onsite audits of service providers.
- Action and respond to inquiries and escalations.
- Make quick-thinking and decisive decisions when handling files.
- Maintain all databases and logs pertaining to investigations.
- Prepare documentation, such as investigation reports, management briefings, or other communications in a professional, confident and proficient manner.
- Research, gather data, and present findings in a variety of settings and to a variety of internal and external stakeholders, including clients, service providers, Legal, internal business partners and senior management.
- Prepare for and participate in regulatory, civil and/or judicial hearings to resolve investigations.
- Promote education and awareness to internal and external stakeholders related to fraud prevention.
- Keep up to date on industry trends and schemes impacting benefit plans.

**What do you need to succeed?**
- Minimum of two years dental industry expertise attained through experience as a dental hygienist, dental assistant, dental office manager, or other related profession
- Strong knowledge of dental terminology and expense codes
- Knowledge of dental insurance benefits and regulatory environments
- Understanding of interviewing and investigative principles and practices
- Strong research and analysis skills
- Understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry
- Strong decision-making skills and innovative thinking
- Ability to effectively negotiate and influence
- Adaptable to a fast-paced environment and can work well independently and collaboratively
- Strong analytical skills with attention to accuracy and details
- Advanced computer skills (Word, Excel, PowerPoint, Outlook, Tableau)
- Fluency in English and French (spoken and written) required due to frequent interactions with internal English
- and French-speaking colleagues or internal partners across Canada

**Assets**
- Previous dental audit / investigation / interviewing experience
- University degree or post-secondary education is an asset

**Location, Travel and Special Notes**:

- This position can be based in Montreal, Waterloo or Toronto with occasional travel.

**What's in it for you?**
- We are proud to be on the 2024 Best Workplaces in Canada list by Great Place to Work.
- We’re also listed as one of the Best Workplaces for Women and Best Workplaces with Most Trusted Executive Teams.
- In 2024, Sun Life ranked among the top 100 most sustainable global corporations by Corporate Knights for the 15th consecutive year, leading Canadian insurers.
- A caring, supportive, and inclusive culture
- Flexible Benefits from the day you join to meet the needs of you and your family
- Time off giving you the flexibility to focus on the moments that matter.
- Care Days available for self-care or care of others (i.e., family or others you may support) and Sick Days to support your well-being.
- LI-MS

We are proud to be a hybrid organization that offers our employees the choice and flexibility to work from both the office and virtually based on the needs of the business, our Clients and you Several work options are available and can be discussed throughout the selection process depending on the role requirements and in