Investigative Analyst, Fraud Risk Management

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

Job Description:

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?

• Detect and prevent group benefits fraud and abuse

• Triage tips and referrals related to inappropriate administration practices of service providers, including obtaining witness statements

• Action and investigate new leads received through our various fraud prevention programs, Operations and the Call Centre

• Conduct phone interviews with Plan Members, Claimants, Providers and Facilities

• Maintain all databases and logs pertaining to alerts and investigations

• Provide support to Investigators by leveraging multiple systems and tools to assist with actively profiling service providers

• Analyze plan member and service provider claim submission patterns to identify trends

• Review claims and determine eligibility

• Respond to inquiries and escalations

• Present findings in a team setting

• Research, conduct social media searches, gather data, prepare and organize documentation for plan sponsors, police 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?

• Excellent communications skills both verbal and written

• Previous audit / Investigation experience within Health and Dental Benefits is an asset

• Strong knowledge of health benefits

• Knowledge of medical terminology

• Needs to be able to work independently within a fast-paced work environment and participate in opportunities to share and learn through group collaboration

• Knowledge and understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry

• Strong decision-making and time management skills

• Advanced computer skills (Word, Excel, Tableau, Outlook)

• 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

• Experience working within audit, investigations, or banking

• Law or accounting background

• Bilingual in English and French

Reasons why you should join us under the sun:

• ​The opportunity to move along a variety of career paths with amazing networking potential

• Flexible Benefits from the day you join to meet the needs of you and your family

• A caring, supportive, and inclusive culture

• We are proud to be on the 2024 Best Workplaces in Canada list by Great Place to Work.

Must be able to obtain RCMP Reliability Security Clearance before a start date can be confirmed (includes fingerprinting).

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 [email protected].

We are proud to be a hybrid organization that offers our employees the choice and flexibility to work from both the office and virtually based on the needs of the business, our Clients and you! Several work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

We may use artificial intelligence to support candidate sourcing, screening, interview scheduling.

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

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