Investigation Analyst – Member Risk

at  Manulife

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JOB DESCRIPTION

Do you have an investigative spirit and want to push your analytical skills and Canadian Health Care Industry knowledge to the next level? If so, Manulife’s Investigation Analyst, Health and Dental Claims Risk Management position might suit you.
Manulife’s Group Benefits Health and Dental Claims Risk Management department is a diverse and dynamic team delivering a broad range of services supporting key operational objectives. Our responsibilities include digital claims risk management, claims abuse management and monitoring programs, fraud investigations, data 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 Investigation Analyst is the prevention, detection, and investigation of fraud and abuse related to plan members. This role will proactively identify risk, champion mitigation strategies, conduct plan member and provider investigations and take actions to protect Manulife benefit plans from fraud. The role may liaise externally with industry contacts and vendors, and internally with Legal, Compliance, Advanced Analytics, Marketing, Customer Service, Client Relations, Ombudsman and the Field as needed.

• Perform risk-based data profiling and analysis to identify trends and outliers in various categories for further review and investigation
• Lead and support audit programs; coordinating, assessing, and making decisions on investigations
• Take initiative and lead investigations to successful conclusions including the preparation of criminal and regulatory complaints
• Conduct interviews of plan members, providers of service and others
• Create written audits and other correspondence to plan members, providers of service and others
• Engages, interacts and consults 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
• Lead, support and implement key investigative projects
• Comfortable delivering effective presentations to new and existing clients
• Travel may be required for this role including the ability to work outside of core working hours