Investigative Analyst

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:

Responsible for the investigation of any situation involving possible dishonest or fraudulent activities in matters pertaining to Providers, Plan Members or Plan Sponsors. Investigations can involve drug, health and dental claiming. Tasks may include identifying fraud and abuse, profiling abusers, assisting with filing complaints and or criminal cases, recovering money, suggesting contractual and administrative updates, be a business expert in health and dental benefits, assist with training and education around fraud and abuse.

What will you do?

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

• Conduct phone or in-person interviews with Plan Members, Patients and or Providers/Facilities

• Maintain all databases and logs pertaining to alerts and investigations

• Prepare/Contribute to reports for trend analysis

• Investigate/Report any situations involving possible fraudulent or dishonest activities

• Provide assistance to resolve allegations of fraud

• Safeguard all information collected

• Make recommendations for process or system improvements

• Assist in the detection and prevention of Fraud/Abuse

• Train our business partners on ways to prevent fraud and abuse

• Keep up to date on industry changes, trends, education, products and privacy laws

What do you need to succeed?

• Strong Knowledge of Drug, Health & Dental Benefits

• Exceptional communication skills both verbal and written

• Knowledge of medical terminology

• Able to work in an independent, fast paced work environment

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

• Strong ability to recognize and report fraudulent / abusive behaviour and claiming

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

• Exceptional decision-making skills

• Excellent PC skills ( Word, Excel, Power Point, Access)

• Bilingualism (French, English, both oral and written) is required for the frequent interactions with English and French-speaking colleagues or internal partners across Canada and worldwide

Preferred skills

• Previous health or dental office experience i.e dental receptionist, medical office reception/manager, Pharmacy assistant or tech etc.

• Previous audit / investigation experience with a focus on Medical and Dental services

What's in it for you?

• 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

• We're committed to creating an inclusive and respectful environment. Our goal is to make sure all our employees have the chance to live up to their full potential

• We're honoured to be recognized as a 2023 Best Workplaces in Ontario by Great Place to Work® Canada

• We are thrilled to be recognized by Excellence Canada with their top-level certification, the Canada Order of Excellence for Mental Health at Work®, for prioritizing employee well-being, fostering a positive work culture, and achieving excellence in mental health

*LI-MS

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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