Bilingual Investigator, Fraud Risk Management Disability Program

at  Sun Life

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.

JOB DESCRIPTION:

Fraud management is increasingly important to policyholders. In order to serve Sun Life’s clients as industry leaders, the Canadian Operations’ Fraud Risk Management area will identify, mitigate and respond to criminal threats using various tools, technologies and strategies.
Reporting to the Fraud Risk Management Manager, the Investigator will investigate situations involving possible dishonest, fraudulent, and/or abusive activities related to Group Benefits claims, with a focus on Disability files. Responsibilities include assessing identified leads, plan sponsors, service providers, and attending physicians, reporting findings to Compliance & Governance and Group Benefit Disability representatives, possibly presenting evidence to police and regulatory bodies, training and consulting, and supporting presentations regarding the Disability Claims Disability Investigation Program.

MAIN ACCOUNTABILITIES:

• Conduct a formal inquiry when fraudulent Disability claims, or related dishonest activity is suspected
• Conduct interviews and take statements from plan members, plan sponsors, service providers, attending physicians, and other third parties
• Prepare and file regulatory complaints and police case referrals
• Contribute to the ongoing evolvement of the Disability Claims Disability Investigations Program
• Assist in coordinating efforts between FRM and Disability Claims to identify and investigate claims fraud and plan abuse
• Provide investigative expertise and related reporting on cases to FRM management, the Ombudsman, Disability Claims, Business Development, Customer Care Centre, and other pertinent internal and external stakeholders
• Collect and safeguard investigation evidence
• Maintain all databases and logs pertaining to investigations
• Identify fraud trends and support data analytics solutions to mitigate the newly identified risk
• Remain current and up to date on industry trends/education/products/privacy laws/etc.
• Assist in training and educating internal and external stakeholders on FRM’s Disability Claims Investigation fraud processes

Please refer the Job description for details