Bilingual Investigation Analyst – Provider Risk

at  Manulife

We are a leading financial services provider committed to making decisions easier and lives better for our customers and colleagues around the world. From our environmental initiatives to our community investments, we lead with values throughout our business. To help us stand out, we help you step up, because when colleagues are healthy, respected and meaningfully challenged, we all thrive. Discover how you can grow your career, make impact and drive real change with our Winning Team today.

JOB DESCRIPTION

The 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, Abuse Management and Monitoring Programs, Fraud Investigations, Technical Support, Analytics, and Claims Experience Management. The effective management of Health and Dental claims experience is imperative to the success of the Group Benefits Operations.
A key focus of the Bilingual Investigation Analyst, Provider Risk is in the prevention, detection, and investigation of fraud and abuse specific to health care providers. This role will proactively identify risk, champion mitigation strategies, conduct provider investigations and take actions to protect Manulife benefit plans from fraud. This role contributes to our claims experience management and the success of our overall Fraud Prevention Program.

• Strong knowledge of Group Benefits
• Certified Fraud Examiner (CFE) designation is an asset
• Knowledge of the Canadian healthcare environment, service delivery model and regulation
• University degree or equivalent work experience
• Strong 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 in both English and French
• Advanced data analysis skills with expertise using Excel and other data mining software
• Skills and ability to analyze and organize data to support analysis and recommendations
• Demonstrated investigation skills with attention to detail
• Advanced interviewing skills
• Ability to coach and mentor more junior staff, acting as question support within connected departments and teams
• Good knowledge of compliance issues governing group benefits, provincial laws and regulations governing insurance, privacy and the criminal and legal framework
• Understanding of emerging threats, associated risks and impact on benefit plans
• Exceptional time management and organizational skills. The ability to manage multiple conflicting priorities in a fast-paced changing environment is essential.