Manager, 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.

This role has a strong leadership and dental knowledge requirement. Reporting to the Director of Fraud Risk Management (FRM), the successful candidate will work closely with contracted Dentists and be accountable for leading a team of dental Investigators and Analysts, who are responsible for fraud detection, prevention and investigation of dental claims across Canada. The successful candidate will work in partnership with other FRM leaders and teams to ensure the successful delivery of all business objectives. They will contribute to setting and prioritizing operational initiatives, creating new processes, leveraging existing techniques and technologies and developing our people to meet current and future business needs. The Manager will also be accountable to identify and prioritize investigations based on contractual obligations, using an intelligence-led approach. They will develop business partnerships with areas that support the team and service delivery such as Legal, Compliance, Group Benefits Customer Care Centre, Group Health & Dental Claims and Business Development.

What will you do?

• Provide day to day leadership to a team of dental Investigators, Analysts and contracted Dental Consultants across various locations.
• Lead direct reports in executing quality service delivery and support them by providing direction, setting clear expectations, coaching, being available, fostering engagement and holding individuals accountable for results.
• Conduct regular assessments on the quality of documentation, prioritization of investigations and decisions made on cases.
• Report on investigative and financial results and safeguard all logs pertaining to investigations.
• Develop operational plans and strategies.
• Support the overall change agenda for FRM ensuring that all change is sustainable.
• Champion a culture of continuous improvement and innovation to deliver on the ever-evolving expectations of our plan members and plan sponsors, and emerging trends related to fraud and abuse matters.
• Collaborate effectively with internal and external stakeholders.
• Monitor emerging trends in dental care to identify potential risk of misuse or abuse of dental claims.
• Participate in speaking engagements, presentations and client meetings.
• Oversee the preparation of delists, regulatory complaints and police referrals.

What do you need to succeed?

• Minimum of two years experience leading a team focused on fraud and abuse management, criminal investigations or equivalency.
• Strong knowledge of dental terminology and expense codes.
• Knowledge of group insurance business (products, services, distribution, organization, systems, processes) and regulatory environment.
• Superior leadership skills, ability to influence solutions and facilitate cross-departmental teamwork that meets the needs of the business strategy.
• Excellent relationship and team building skills.
• Strong analytical skills and critical thinking with attention to accuracy and details.
• Presentation and communication skills (written and verbal), interviewing and experience presenting sensitive matters to customers or senior management.
• Solid decision-making skills by understanding and assessing business needs and risks.
• Superior organizational skills and ability to multi-task, prioritize initiatives and execute effectively.
• As this position is posted in several locations, we specify that bilingualism (French, English, both oral and written) is required for Quebec only as the position includes managing both French and English-speaking staff (Quebec and outside Quebec) and providing daily support to the team.

Assets

• Dental industry expertise attained through experience as a dentist, dental hygienist, dental assistant or dental office manager.
• Experience working within investigations, audit, or policing.

Special Notes

• Some travel may be required.
• The candidate selected for this role is required to attain Canadian Reliability Security Clearance (administered by submitting fingerprints to the RCMP, who then conduct min. 5 year history checks). To see if you are eligible for this clearance, please review the section 201 on the Federal Government site ( https://www.tpsgc-pwgsc.gc.ca/esc-src/personnel/pdcf-rsrp-eng.html)

What's in it for you?

• A friendly, collaborative and inclusive culture
• An environment of continuous learning and improvement
• Supportive working environment, culture of collaboration, high performance teams
• 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
• Our unique Sabbatical Program gives you the opportunity to take up to 6 weeks off, every five years.
• We’re proud to be recognized as a company with a 2023 Most Trusted Executive team by Great Place to Work® Canada
• Sun Life ranked one of the 2023 Global 100 Most Sustainable Corporations in the World on the Corporate Knights’ 2023

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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