Drug Investigation Consultant

**_Are you looking for a supportive, collaborative workplace with great teams and inspiring leaders? You’ve come to the right place. We’re looking for ambitious people who share our values and want to make every day better for people around the world. If this sounds like you, and the career below sounds exciting, we’d like to hear from you. _**

**Working Arrangement**

Hybrid

**The Opportunity**

**Responsibilities**:

- Perform risk-based data profiling and analysis to identify trends and outliers for further review and investigation as it relates to drug claims
- Lead and support audit programs; coordinating, assessing, and making decisions on investigations
- Conduct plan member reviews in regard to drug usage and therapeutics in accordance with provincial and federal guidelines and laws
- Conduct interviews and take statements from plan members, health care providers and others while maintaining investigation notes and case management details
- Prepare and submit official complaints to regulatory colleges
- Create written audits and other correspondence to plan members, health care providers and others
- Act as Subject Matter Expert for drug related claims related to audit and fraud investigations
- Lead, support and implement key investigative projects
- Work with our PBM (Pharmacy Benefit Manager) to maintain and modify our pharmacy audit program
- Present to internal departments and external clients
- Engage, interact, and consult 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

**How will you create impact?**

The Drug Investigation Consultant is a vital member of the Investigation Services Team that helps to protect plan sponsors and members from the negative impacts of drug claims fraud. This role is dedicated to preventing, detecting, and investigating incidences of fraud, waste and abuse against its benefit plans.
**What motivates you?**
- You obsess about customers, listen, engage and act for their benefit.
- You think big, with curiosity to discover ways to use your agile approach and enable business outcomes.
- You thrive in teams and enjoy getting things done together.
- You take ownership and build solutions, focusing on what matters.
- You do what is right, work with integrity and speak up.
- You share your humanity, helping us build a diverse and inclusive work environment for everyone.

**What we are looking for**
- Knowledge of Group Benefits
- Knowledge of drug benefit plan designs, provincial drug plans, drug categories both prescription and non-prescription, customary doses and prescription requirements
- Knowledge of provincial narcotics programs along with narcotic dosing and guidelines
- University degree or equivalent work experience
- Minimum of 3-5 years retail pharmacy experience
- Knowledge of third-party adjudication as it relates to pharmacy claims
- Knowledge of fraud and abuse risk, and techniques to manage risk
- Ability to manage contentious interactions with various stakeholders and take control of stressful situations with tact and diplomacy
- Excellent oral and written communication skills and ability to interview service providers, plan members and others
- Resourceful with a proven analytical, problem solving, and troubleshooting background
- Knowledge of privacy, civil and criminal legal risks, and processes
- Ability to be skeptical, probing, creative and aggressive in conducting authentication and investigation activity

**What can we offer you?**
- A competitive salary and benefits packages.
- A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.
- A focus on growing your career path with us.
- Flexible work policies and strong work-life balance.
- Professional development and leadership opportunities.

**Our commitment to you**
- Values-first culture
We lead with our Values every day and bring them to life together.
- Boundless opportunity
We create opportunities to learn and grow at every stage of your career.
- Continuous innovation
We invite you to help redefine the future of financial services.
- Delivering the promise of Diversity, Equity and Inclusion
We foster an inclusive workplace where everyone thrives.
- Championing Corporate Citizenship
We build a business that benefits all stakeholders and has a positive social and environmental impact.

M-CA-IN-CM

LI

**About John Hancock and Manulife**

**Manulife is an Equal Opportunity Employer