Investigation Analyst - Member Risk

Manulife’s Group Benefits Health and Dental Claims Risk Management department is a diverse and dynamic team supporting key operational objectives through digital claims risk management, claims abuse monitoring, fraud investigations, data analytics, and claims experience management. Effective management of health and dental claims is crucial for the success of group benefits operations. The Investigation Analyst leverages analytical skills, investigative expertise, customer focus, and knowledge of the Canadian Healthcare environment to manage ongoing risk management priorities.

A key focus is the prevention, detection, and investigation of fraud and abuse related to plan members, proactively identifying risks and championing mitigation strategies. This role involves conducting investigations and liaising with industry contacts, vendors, and internal departments like Legal and Compliance.

Reporting to the Senior Manager, Fraud Risk Management, the Analyst helps protect plan sponsors and members from claims fraud. Focused on plan member risk mitigation, this role is fundamental to the success of our investigation programs and claims risk management.

Position Responsibilities:

• Perform risk-based data profiling and analysis to identify trends and outliers in various categories for further review and investigation

• Lead and support audit programs; coordinating, assessing, and making decisions on investigations

• Take initiative and lead investigations to successful conclusions including the preparation of criminal and regulatory complaints

• Conduct interviews of plan members, providers of service and others

• Create written audits and other correspondence to plan members, providers of service and others

• Engages, interacts and consults with various internal contacts such as Customer Service, Legal, Client Relations, Medical Consultants, Regional Group Office and external stakeholders such as Health Practitioner Regulatory Bodies, Colleges and Associations, and Plan Sponsors

• Lead, support and implement key investigative projects

• Comfortable delivering effective presentations to new and existing clients

Required Qualifications:

• Knowledge of Group Benefits

• University degree or equivalent work experience

• Knowledge of the Canadian healthcare environment, service delivery model and regulation

• Excellent oral communication (both phone and face-to-face) and written communication skills

• Knowledge of fraud and abuse risk, and techniques to manage risk
  
  

Preferred Qualifications:

• CFE designation is an asset

• Organizational skills and the ability to manage multiple conflicting priorities

• Demonstrated investigation skills with attention to detail

• Strong research, problem-solving and decision-making skills

• Ability to be creative, critical and aggressive in managing audit and investigative activities

• Intermediate or higher data analysis skills with expertise using Excel and other data mining software

• Ability to manage contentious interactions with various stakeholders

When you join our team:

• We’ll empower you to learn and grow the career you want.

• We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.

• As part of our global team, we’ll support you in shaping the future you want to see.

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About Manulife and John Hancock

Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit https://www.manulife.com/en/about/our-story.html.

Manulife is an Equal Opportunity Employer

At Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.

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 Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact recruitment@manulife.com.

Referenced Salary Location

Salary range is expected to be between

If you are applying for this role outside of the primary location, please contact recruitment@manulife.com for the salary range for your location. The actual salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education/training. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.

Manulife offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans. We also offer eligible employees various retirement savings plans (including pension and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in Canada includes holidays, vacation, personal, and sick days, and we offer the full range of statutory leaves of absence. If you are applying for this role in the U.S., please contact recruitment@manulife.com for more information about U.S.-specific paid time off provisions.