Complex Investigative Review Specialist

Permanent Full Time 

-

We are currently hiring for an Investigator 3 within Fraud Management, Workplace Solutions.

The Investigator 3 role is a key member of the Fraud Management team and will be responsible for conducting large scale and complex investigations of healthcare providers and plan members, assessing case information, formulating investigative plans, collecting evidence and taking appropriate actions based on findings.
 
To be successful in this role, you must possess superior written and verbal communication, analytical and problem solving and organization skills, attention to detail and the ability to accurately and thoroughly document case information and findings.
 
This is a hybrid position – the successful applicants will be required to work 3 days a week in office with flexible working hours within our core business hours of 7am-5pm CST.
 
What you will do: 
•    Conduct thorough investigations into suspected fraud and abuse of health/dental insurance benefits, identified through various detection channels
•    Analyze and interpret financial records, claims data and information from internal and external sources
•    Develop and execute investigative plans to obtain evidence where fraud or abuse is suspected
•    Communicate with appropriate parties (verbal and/or written), including plan member, claimant and/or providers
•    Work collaboratively with the industry and internal Fraud Management team including leaders, other investigators and intelligence analysts
•    Consult with Health and Dental subject matter experts and internal medical boards and/or consultants, regulatory bodies, Legal or other internal departments as warranted by the case
•    Accurately document investigative actions and outcomes according to department best practices
•    Where evidence supports an action, determine and execute the appropriate action according to established protocols
•    Create comprehensive summaries regarding investigative findings to support client reporting, recovery of funds, criminal or civil actions, and labour relations actions as needed
•    Identify opportunities to mitigate future risk
•    Collaborate on special projects as assigned including targeted investigations, department process innovations and system enhancements
•    Participate in training and mentorship opportunities to other members of the team
•    Keep current on industry trends and maintain appropriate professional development

What you will bring: 
•    Due to the high profile of a number of our clients, a Federal Government Enhanced Screening is a job requirement which will involve fingerprinting and a credit check
•    5+ years related work experience leading investigations into complex health and/or dental claims fraud
•    Proven ability to work as part of a collaborative team
•    Strong understanding of Group and Individual health and dental insurance  
•    Completion of post-secondary level education (e.g. university or college degree/diploma)
•    A combination of relevant experience and education will be considered
•    Solution oriented with strong decision-making, problem-solving skills and analytical skills
•    Strong customer service mindset
•    Excellent communication skills, both verbal and written, in fast-paced and unscripted situations
•    Excellent organizational and time management skills; able to manage multiple, simultaneous investigations and re-prioritize as priorities change
•    Demonstrated proficiency using Microsoft applications such as Excel, Word and Outlook
•    CFE or professional designation in a relevant regulated healthcare field would be considered an asset
•    Bilingual in English and French is an asset

Benefits: 
•    Opportunities to carry out challenging work in a dynamic, collaborative and fast-growing team
•    Leaders who support your development in a friendly, supportive work environment
•    A competitive and comprehensive rewards program including tuition reimbursement, bonuses and flexible benefits
•    Paid vacation, personal days and employee volunteer day allotment
•    The opportunity to participate in a variety of teambuilding activities and professional development activities that help to strengthen your skills and build strong relationships within the department and company
•    Access to various sports leagues such as hockey and indoor soccer, an on-site fitness centre and cafeteria
 

-

The base salary for this position is between  $50,400.00 - $83,900.00 annually.  This represents base salary only and does not represent other variable compensation components of our total compensation ( i.e. annual bonus, commission etc).  If you are selected to move forward in our recruitment process, your recruiter will be able to discuss additional details of our total rewards program with you.

Career opportunities will be open a minimum of 5 business days from the date of posting, closing dates will vary depending on the search activity. All applications received will be reviewed on a rolling basis.

Be your best at Canada Life- Apply today!

Being a part of Canada Life means you have a voice. This is a place where your unique background, perspectives and talents are valued, and shape our future success.

You can be your best here. You’re part of a diverse and inclusive workplace where your career and well-being are championed. You’ll have the opportunity to excel in your way, finding new and better ways to deliver exceptional customer and advisor experiences.

Together, as part of a great team, you’ll deliver on our shared purpose to improve the well-being of Canadians. It’s our driving force. Become part of a strong and successful company that’s trusted by millions of Canadians to do the right thing.

Canada Life serves the financial security needs of more than 13 million people across Canada, with additional operations in Europe and the United States. As members of the Power Financial Corporation group of companies, we’re one of Canada’s leading insurers with interests in life insurance, health insurance, investment and retirement savings. We offer a broad portfolio of financial and benefit plan solutions for individuals, families, businesses and organizations. 

We are committed to providing an inclusive, accessible environment, where all employees and customers feel valued, respected and supported. We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employee has the opportunity to reach their potential. 

It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Canada Life policies. To request a reasonable accommodation in the application process, contact talentacquisitioncanada@canadalife.com.

Canada Life would like to thank all applicants, however only those who qualify for an interview will be contacted.

#LI-Hybrid