Investigative Analyst, Fraud Risk Management

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Job Description:

Location: Hybrid

Fraud management is increasingly important to policyholders. To serve Sun Life’s clients as industry leaders, Canadian Operations’ Fraud Risk Management area will identify, mitigate and respond to criminal threats using various tools, technologies and strategies. Reporting to the Manager for Fraud Risk Management, the Investigative Analyst will work in partnership with Investigators in the identification and investigation of situations involving suspected dishonest and fraudulent claiming activities pertaining to medical service providers and plan members.

Using advanced analytics, innovative thinking and investigative excellence, the successful candidate will complete several daily tasks, largely focusing on service provider and collusion schemes involving medical providers and facilities. They will collaborate across teams in the prevention and detection of criminal activity that can threaten the sustainability of group benefit plans.

What will you do?

• Assist in the detection and prevention of fraud and abuse
• Provide support to the Investigator on active profiling of service providers
• Conduct plan member and service provider claiming behaviour reviews and identify trends
• Review claims and determine eligibility
• Respond to inquiries and escalations
• Support the Investigator by attending site audits
• Assist in interviewing plan members
• Present findings in a team setting
• Assist in the preparation of de-list recommendations
• Research, conduct social media searches, gather data, prepare and organize documentation for plan sponsors, law enforcement and management
• Promote education and awareness to internal and external stakeholders related to fraud prevention
• Make recommendations for continuous improvement
• Timely documentation of investigative steps and outcomes
• Keep up to date on trends and schemes impacting benefit plans

What do you need to succeed?

• Experience working in audits, investigations, or banking fraud prevention
• Strong analytical skills, critical thinking and attention to accuracy and detail
• Knowledge of group insurance and its regulatory context
• Advanced technical and computer skills (Excel, Word, Adobe, Outlook, PowerPoint, Tableau)
• Excellent communication skills both verbal and written
• Knowledge and understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry
• Ability to work independently and participate in opportunities to share and learn through group collaboration
• Knowledge of health benefits or medical terminology
• Strong decision-making skills
• Ability to detect processes to reduce abusive practices affecting group plans
• As this position is posted in several locations, we specify that bilingualism (French, English, both oral and written) is required for Quebec only for the frequent interactions with English and French-speaking colleagues or internal partners across Canada or worldwide.

Assets

• University degree or postsecondary education

Unique requirements

• As a condition of the role, the successful candidate must obtain a Government of Canada Reliability Status security clearance through Sun Life in advance of the start date.
• The incumbent can work hybrid from Waterloo, Toronto or Montreal.

#LI-Hybrid

The Base Pay range is for the primary location for which the job is posted. It may vary depending on the work location of the successful candidate or other factors. In addition to Base Pay, eligible Sun Life employees participate in various incentive plans, payment under which is discretionary and subject to individual and company performance. Certain sales focused roles have sales incentive plans based on individual or group sales results.

Diversity and inclusion have always been at the core of our values at Sun Life. A diverse workforce with wide perspectives and creative ideas benefits our clients, the communities where we operate and all of us as colleagues. We welcome applications from qualified individuals from all backgrounds.

Persons with disabilities who need accommodation in the application process or those needing job postings in an alternative format may e-mail a request to thebrightside@sunlife.com.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

We thank all applicants for showing an interest in this position. Only those selected for an interview will be contacted.

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