Hybrid Investigation Analyst – Provider Risk

at Manulife

• Job title: Investigation Analyst – Provider Risk
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: CA$43,875 - CA$73,125 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Waterloo, Canada

About the role

• Investigation Analyst in Provider Risk at Manulife focusing on fraud prevention, detection, and investigation in the healthcare sector, working with internal teams and stakeholders.

Responsibilities

• Perform risk-based data profiling to identify trends and outliers, leading investigations to successful conclusions, including preparing criminal and regulatory complaints.
• Lead and support audit programs by coordinating, assessing, and making decisions on investigations, and conducting interviews with plan members and service providers.
• Create written audits and correspondence for plan members and service providers, while engaging with internal and external stakeholders to ensure comprehensive investigation processes.

Requirements

• Knowledge of Group Benefits
• Knowledge of the Canadian healthcare environment, service delivery model and regulation
• University degree or equivalent work experience
• CFE designation is an asset
• 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
• Intermediate or higher data analysis skills with expertise using Excel and other data mining software
• Demonstrated investigation skills with attention to detail
• Ability to be creative, critical and aggressive in managing audit and investigative activities
• Organizational skills and the ability to manage multiple conflicting priorities

Benefits

• health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage
• adoption/surrogacy and wellness benefits
• employee/family assistance plans
• various retirement savings plans (including pension and a global share ownership plan with employer matching contributions)
• financial education and counseling resources
• generous paid time off program including holidays, vacation, personal, and sick days, and the full range of statutory leaves of absence