Hybrid Investigator, Fraud Risk Management, Disability Program

at Sun Life

• Job title: Investigator, Fraud Risk Management, Disability Program
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: CA$58,000 - CA$93,000 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Waterloo, Canada

About the role

• Investigator responsible for conducting investigations into fraud related to Disability claims at Sun Life. Engaging with various stakeholders and utilizing advanced data analytics to mitigate risks.

Responsibilities

• Conduct a formal investigation when there is suspected misrepresentation or alternate employment on a Disability claim
• Engage in phone and email communication with plan sponsors, service providers, disability case managers, and other third parties
• Leverage advanced, open-source search techniques, data analytics tools, and digital investigation frameworks to support organizational objectives and inform strategic decision-making
• Document findings utilizing technology platforms and formal reports
• Conduct phone interviews with plan members
• Prepare and deliver compelling presentations of investigative findings to internal stakeholders, across various levels
• Engage in collaborative efforts between other FRM teams and Disability to identify and investigate claim misrepresentation or suspected fraud
• Maintain accurate documentation of all case notes and findings in an internal case management system
• 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
• Contribute to the ongoing evolvement of the Disability Investigations process

Requirements

• Experience and formal training in investigations, preferably within insurance or group benefits
• Formal interview training and/or experience
• Exceptional OSINT research skills
• Strong presentation and communication skills with experience utilizing Microsoft Teams
• Experience preparing comprehensive report summaries of investigative findings
• Ability to apply critical thinking and innovative approaches when analyzing investigative findings
• Take ownership of decisions and their outcomes while maintaining accountability for results
• Demonstrated success as an individual contributor who can also effectively collaborate within a team
• Knowledge and understanding of contractual language, administration guidelines, and provincial and federal legislation
• Knowledge in Disability claims, including short and long-term claims and Group Benefits, an asset
• Familiarity with medical terminology, an asset
• Bilingualism (French, English) required for Quebec only for the frequent interactions with English and French-speaking colleagues or internal partners across Canada or worldwide

Benefits

• A hybrid organization facilitating a better work/life balance
• Flexible Benefits
• Pension Plan
• Stocks Ownership
• Time off