Program Manager, Investigation Services

The Risk Management Department is a diverse and dynamic team delivering a broad range of services in support of key operational objectives. Our responsibilities include Digital Claims Risk Management, Abuse Management and Monitoring Programs, Fraud Investigations, Technical Support, 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 Program Manager, Investigation Services is accountability for managing fraud and abuse for our Drug and Dental benefits and innovating relative programs to match future needs.

The Program Manager, Investigation Services is responsible for leading teams of anti-fraud specialists to mitigate, investigate and deter fraud and abuse; directing the activities for our former law enforcement professionals; executing anti-fraud programs to support new business strategies, providing leadership and advice to variety of business lines including Group Benefits and Affinity; supporting our Regional Offices, Plan Sponsors, and Customers, and developing and delivering fraud risk presentations. This role leads or supports industry anti-fraud working groups, seeks opportunities to foster Plan Sponsor and member fraud awareness through presentations and other communication vehicles, and has accountability for building fraud awareness within Manulife Group Benefits. The Manager monitors financial, legal and reputational risk and works with Legal, Compliance, RGO and others to resolve complex and sensitive issues.

Responsibilities

• Lead teams of anti-fraud professionals to prevent, detect, investigate and deter fraud and abuse

• Create high-performance teams by providing staff with continuous development and mentoring, and opportunities for them to build on their investigation capabilities

• Develop and deliver anti-fraud programs in compliance with Manulife’s Fraud policy, regulators’ expectations (e.g. OSFI), client expectations and commitments, and compliance and legislative requirements (e.g. SOX)

• Manage investigation service levels and prioritize dental and drug program tips and alerts and lead the development of investigation and communication plans for dialogue and negotiation with service providers

• Monitor and build on analytical controls for effective identification of actionable cases and identify weaknesses and gaps to close for ongoing effective fraud risk management

• Identify new and emerging risks to Group Benefits and Affinity business lines and drive requirements (e.g. fraud analytics and tools) and tactics to proactively address and mitigate financial and reputational risks thereby minimizing negative impact to Manulife, our customers, and shareholders

• Influence or direct appropriate actions on fraud cases including pursuing recovery of payments, regulatory complaints, criminal complaints, civil actions and client communications, through employing a strong understanding of the criminal, civil, legal, and compliance/privacy framework and considering customer expectations

• Provide leadership on complex, escalated cases involving significant legal, privacy, and reputational risk and ensure that proper legal and compliance advice is sought, that appropriate senior management is kept informed, and that appropriate decisions are made.

• Provide Group Benefits with expert fraud risk advice related to new products and services, product changes, legislative changes and emerging fraud schemes.

• Promote fraud awareness externally with our Plan Sponsors, Advisors, and Consultants, and internally through the development and delivery of awareness modules to internal Group Benefits and Affinity staff.

• Lead client meetings addressing sensitive audits and investigations with Plan Sponsors and support client requests through our Regional Group Offices and Customer Service Centres

• Deliver presentations to existing clients. Respond and present to prospective clients through the Request for Proposal (RFP) process

• Manage expenses within the approved budget

• Monitor financial results of investigation programs

• Pursue opportunities to create efficiencies within programs

• Lead the continued development of the investigative model to manage high-risk providers and suspicious transactions and support analytics staff with the continuous development and enhancement of Fraud Data Analytics addressing existing, new, and emerging risk

• Perform risk assessments, develop risk-mitigating strategies and deliver controls to protect the benefits investment of our clients

• Understand and maintain current knowledge of audit and investigative techniques, tools, software and technology

• Work with key stakeholders including dental and pharmaceutical provider associations and colleges, government bodies and law enforcement; developing and strengthening relationships to influence change, collaborating on shared issues to develop solutions, and identifying and developing ongoing information and education for consumers, stakeholders and industry members

• Assist in protecting and preserving Group Benefits marketplace competitive advantages through ongoing enhancement of fraud prevention program activities

• Lead or participate in industry anti-fraud and related working groups representing the interests of both our customers and shareholders to mitigate fraud, waste, and abuse

• Develop communication material for external and internal publications, clients’ newsletters, provider education and fraud presentations.

• Prepare internal and external reports on program activities, fraud risk exposure and program outcomes

How will you create impact?

This role reports to the Director, Fraud & Investigation, and helps to protect plan sponsors and members from the negative impacts of claims fraud. This role is focused on dental and pharmaceutical claim risk mitigation, which is a key part of the foundation for our investigation programs and a vital part of claims risk management.

What motivates you?

• You obsess about customers, listen, engage and act for their benefit.

• You think big, with curiosity to discover ways to use your agile approach and enable business outcomes.

• You thrive in teams and enjoy getting things done together.

• You take ownership and build solutions, focusing on what matters.

• You do what is right, work with integrity and speak up.

• You share your humanity, helping us build a diverse and inclusive work environment for everyone

What we are looking for

• Bachelor’s degree in the related field, a formal fraud designation, preferably a Certified Fraud Examiner (CFE) and between 5 to 10 years of experience in the financial services industry with at least 5 years in a risk management role and a commitment to continuing education

• Strong people leadership skills with a proven track record of motivating, inspiring, empowering, developing and mentoring individuals and teams for successful outcomes

• Demonstrates strong business acumen, critical thinking and problem-solving abilities

• An experienced leader with demonstrated strong business acumen and excellent communication, presentation, influencing, negotiating, critical thinking and problem-solving skills.

• Relationship management skills in dealing with internal business units and staff at all levels and external parties including industry associations, competitors, regulators, external auditors, third-party payors, plan sponsors, members, providers, and sales industry participants.

• Excellent understanding of Canadian criminal and civil law, and overall compliance, privacy and legal framework.

• Sound knowledge of Manulife’s business activities, policies, products and strategies

• Strong analytical skills and advanced working knowledge of Excel, Word and PowerPoint

• Demonstrated knowledge of formal forensic and investigative techniques

• Ability to stay calm in a fast-paced environment and manage conflicting priorities within tight deadlines

• Ability to make effective presentations and influence decisions

• Self-motivated and strong drive for successful outcomes

• Superior collaborative abilities to facilitate partnerships at all levels across the Canadian division

• Customer-focused with the ability to adjust and adapt in an ever-changing environment

• Strong management skills to coach, mentor, and develop individuals and lead teams to deliver on core objectives

• A motivator who can inspire and empower teams to achieve high performance and create a continual high-performance environment

• Effective communicator who can interact with individuals at all levels both internally and externally and influence change and acceptance of innovative and strategic approaches to solve complex issues

• Confident and effective decision maker and empowers direct reports to make decisions

• Problem Solver and Decision Making

What can we offer you?

• A competitive salary and benefits package.

• A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.

• A focus on growing your career path with us.

• Flexible work policies and strong work-life balance.

• Professional development and leadership opportunities.

Our commitment to you

• Values-first culture: We lead with our Values every day and bring them to life together.

• Boundless opportunity: We create opportunities to learn and grow at every stage of your career.

• Boundless opportunity: We invite you to help redefine the future of financial services.

• Delivering the promise of Diversity, Equity and Inclusion: We foster an inclusive workplace where everyone thrives.

• Championing Corporate Citizenship: We build a business that benefits all stakeholders and has a positive social and environmental impact.

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À propos de Manuvie et de John Hancock

La Société Financière Manuvie est un chef de file mondial des services financiers qui aide les gens à prendre leurs décisions plus facilement et à vivre mieux. Pour en apprendre plus à notre sujet, rendez vous à l’adresse www.manuvie.com.

Manuvie est un employeur qui souscrit au principe de l’égalité d’accès à l’emploi

À Manuvie/John Hancock, nous embrassons notre diversité. Nous nous efforçons d’attirer, de perfectionner et de maintenir un effectif qui est aussi varié que nos clients, et de favoriser la création d’un milieu de travail inclusif qui met à profit la diversité de nos employés et les compétences de chacun. Nous nous engageons à assurer un recrutement, une fidélisation, une promotion et une rémunération équitables, et nous administrons toutes nos pratiques et tous nos programmes sans discrimination en raison de la race, de l’ascendance, du lieu d’origine, de la couleur, de l’origine ethnique, de la citoyenneté, de la religion ou des croyances ou des convictions religieuses, du genre (y compris grossesse et affection liée à une grossesse), de l’orientation sexuelle, des caractéristiques génétiques, du statut d’ancien combattant, de l’identité de genre, de l’expression de genre, de l’âge, de l’état matrimonial, de la situation de famille, d’une invalidité ou de tout autre motif protégé par la loi applicable.

Nous nous sommes donné comme priorité d’éliminer les obstacles à l’accès égalitaire à l’emploi. C’est pourquoi un représentant des Ressources humaines collaborera avec les candidats qui demandent une mesure d’adaptation raisonnable pendant le recrutement. Tous les renseignements communiqués pendant le processus de demande de mesures d’aménagement seront stockés et utilisés conformément aux lois et aux politiques applicables de Manuvie/John Hancock. Pour demander une mesure d’aménagement raisonnable dans le cadre du recrutement, écrivez à recruitment@manulife.com.

Région principale

Semaine de travail comprimée

L’échelle salariale devrait se situer entre

Si vous posez votre candidature à ce poste en dehors de la région principale, veuillez écrire à recruitment@manulife.com pour obtenir l’échelle salariale correspondant à votre région. Le salaire varie en fonction des conditions du marché local, de la géographie et de facteurs pertinents liés au poste telles les connaissances, les compétences, les qualifications, l’expérience et l’éducation ou la formation. Les employés ont également la possibilité de participer à des programmes de motivation et de toucher une rémunération incitative liée au rendement de l’entreprise et au rendement individuel.

Manuvie offre aux employés admissibles une vaste gamme d’avantages sociaux personnalisables, notamment une assurance soins médicaux, soins dentaires, santé mentale, soins de la vue, invalidité de courte et de longue durée, assurance vie et assurance DMA, assurance adoption, de maternité de substitution et de soins médicaux non urgents ainsi que des programmes d’aide aux employés et leur famille. Nous proposons également aux employés admissibles différents régimes d’épargne-retraite (y compris des régimes de rente et un programme international d’actionnariat assortie de cotisations patronales de contrepartie) ainsi que des ressources en matière d’éducation et de conseils financiers. Notre généreux programme de congés rémunérés au Canada comprend les jours fériés, les congés annuels, les congés personnels et les congés de maladie, et nous offrons toute la gamme des congés autorisés prévus par la loi. Si vous posez votre candidature à ce poste aux États-Unis, veuillez écrire à recruitment@manulife.com pour obtenir de plus amples renseignements sur les dispositions relatives aux congés rémunérés spécifiques aux États-Unis.