Risk Manager executing responsibilities in Risk Management, overseeing committees and operational risks for UK financial services industry. Assisting CRO and collaborating with teams for effective risk management.
About the role
- Manager leading a team for fraud risk management at Sun Life. Overseeing proactive fraud prevention efforts and utilizing advanced analytics in health benefits.
Responsibilities
- Provide leadership to a team of investigative analysts and investigators focused on proactive due diligence and early detection of collusion-based fraud schemes
- Drive the strategic use of advanced analytics to identify high-risk providers and suspicious patterns before significant losses occur
- Oversee the preparation of delists, regulatory complaints and police referrals
- Measure and report on the effectiveness of proactive fraud prevention initiatives, demonstrating return on investment and loss avoidance
- Develop the team's competencies in advanced analytics, investigative techniques, and emerging fraud detection methodologies to fully utilize individual team members' strengths and talents
- Lead and support direct reports in executing quality service delivery, providing direction, setting clear expectations, coaching, being available, providing recognition and holding individuals accountable for results
- Conduct regular assessments on the quality of documentation, risk-based prioritization of investigations and decisions made on cases
- Champion a culture of continuous improvement and innovation to deliver on the ever-evolving expectations of our plan members and plan sponsors on fraud and abuse matters
- Participate in projects involving new technologies, processes and practices
- Monitor emerging trends in health care to identify potential risk of misuse or abuse of health and dental claims.
Requirements
- Bilingualism (French, English, both oral and written) is required for Quebec only
- Experience leading a team focused on fraud and abuse management, criminal investigations or equivalent
- Proficiency in data analytics and data interpretation for fraud detection purposes
- Strong analytical skills and critical thinking with attention to accuracy and details
- Knowledge of group insurance business (products, services, distribution, organization, systems, processes) and regulatory environments
- Understanding of extended health benefits, billing practices, and health related fraud schemes
- Strong leadership skills, ability to influence solutions and facilitate cross-departmental teamwork that meets the needs of the business strategy
- Excellent communication skills (written and verbal) and experience presenting sensitive matters to customers or senior management
- Proven presentation skills
- Solid decision-making skills by understanding and assessing business needs and risks
- Superior organizational skills and ability to multi-task, prioritize initiatives and execute effectively
- Experience with case management systems and fraud detection software
- Advanced computer skills (Excel, Tableau, or similar analytical tools)
- University degree or postsecondary education
- Experience implementing or managing proactive fraud prevention programs
- Certifications such as CFE (Certified Fraud Examiner), CFCI (Certified Financial Crimes Investigator), or similar credentials
- Fluency in two or more languages
- Must be able to obtain RCMP Reliability Security Clearance before a start date can be confirmed (includes fingerprinting).
Benefits
- Flexible Benefits from the day you join to meet the needs of you and your family
- A caring, supportive, and inclusive culture
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