- LOCATION:NONE
Hybrid
We are a leading financial services provider committed to making decisions easier and lives better for our customers and colleagues around the world. From our environmental initiatives to our community investments, we lead with values throughout our business. To help us stand out, we help you step up, because when colleagues are healthy, respected and meaningfully challenged, we all thrive. Discover how you can grow your career, make impact and drive real change with our Winning Team today.
Working Arrangement
Job Description
The Risk Management Department is a diverse and dynamic team delivering a broad range of services in support of key operational objectives. Our responsibilities include Digital Claims Risk Management, Abuse Management and Monitoring Programs, Fraud Investigations, Technical Support, Analytics, and Claims Experience Management. The effective management of Health and Dental claims experience is imperative to the success of the Group Benefits
Operations.
A key focus of the Bilingual Investigation Analyst, Provider Risk is in the prevention, detection, and investigation of fraud and abuse specific to health care providers. This role will proactively identify risk, champion mitigation strategies, conduct provider investigations and take actions to protect Manulife benefit plans from fraud. This role contributes to our claims experience management and the success of our overall Fraud Prevention Program.
Responsibilities
- Strong knowledge of Group Benefits
- Certified Fraud Examiner (CFE) designation is an asset
- Knowledge of the Canadian healthcare environment, service delivery model and regulation
- University degree or equivalent work experience
- Strong knowledge of fraud and abuse risk, and techniques to manage risk
- Strong research, problem-solving and decision-making skills
- Ability to manage contentious interactions with various stakeholders
- Excellent oral communication (both phone and face-to-face) and written communication skills in both English and French
- Advanced data analysis skills with expertise using Excel and other data mining software
- Skills and ability to analyze and organize data to support analysis and recommendations
- Demonstrated investigation skills with attention to detail
- Advanced interviewing skills
- Ability to coach and mentor more junior staff, acting as question support within connected departments and teams
- Good knowledge of compliance issues governing group benefits, provincial laws and regulations governing insurance, privacy and the criminal and legal framework
- Understanding of emerging threats, associated risks and impact on benefit plans
- Exceptional time management and organizational skills.The ability to manage multiple conflicting priorities in a fast-paced changing environment is essential.
How will you create impact?
The Bilingual Investigation Analyst, Provider Risk will draw on their analytical skills, investigative expertise, customer focus, Group Benefits background, understanding of the Canadian Healthcare environment, regulation, and legislation to determine the ongoing priorities in the delivery of provider controls.
This role will investigate providers and identify those with inappropriate and/or fraudulent business practices taking actions including putting forth recommendations in handling including delisting specific providers from payment across our block. The Bilingual Investigation Analyst must be highly skilled in decision making and negotiating as this role will be regularly confronted with potentially contentious situations requiring immediate and appropriate responses.
This role must be a confident communicator with an investigative background, have a technical aptitude with experience using analytical tools, demonstrate leadership skills to provide mentoring to more junior roles and understand the regulatory and legislative environment across the country in particular as it relates to healthcare and privacy.
This role reports to the Director, Fraud & Investigation, and helps to protect plan sponsors and members from the negative impacts of claims fraud. This role is focused on provider risk mitigation, which is a key part of the foundation for our investigation programs and a vital part of claims risk management.
A key function of the Bilingual Investigation Analyst, Provider Risk role is the investigation of service providers, coaching of more junior staff through question support and guidance, representation of the overall program to management, and providing support for reporting and KPIs on an ongoing basis.
What motivates you?
- You obsess about customers, listen, engage and act for their benefit.
- You think big, with curiosity to discover ways to use your agile approach and enable business outcomes.
- You thrive in teams and enjoy getting things done together.
- You take ownership and build solutions, focusing on what matters.
- You do what is right, work with integrity and speak up.
- You share your humanity, helping us build a diverse and inclusive work environment for everyone
What we are looking for
- Bilingual (French & English) is required - The successful candidate will be required to communicate in English and French in order to support clients from various jurisdictions outside of Quebec.
- Conduct face-to-face or phone interviews of providers, provider office staff, and prescribers in the course of audits or investigations.
- Respond to difficult and challenging situations requiring immediate decisions and/or negotiation
- Support the continued development of the investigative model to manage high risk providers and suspicious transactions and support analytics staff with the continuous development and enhancement of Fraud Data Analytics addressing existing, new, and emerging risk
- Perform risk assessments, develop risk-mitigating strategies and deliver controls to protect the benefit investment of our clients.
- Understand and maintain current knowledge of audit and investigative techniques, tools, software and technology
- Provide mentoring to more junior staff in the detection of deception through data analysis, written and verbal verification requests identifying providers for monitoring and investigation.
- Actively participate in sensitive plan sponsor meetings with senior client personnel from legal, benefits, corporate investigations and their audit risk committees leading the discussion and/or delivering presentations
- Represent Manulife internally and externally on stakeholder meetings, project working groups, industry associations and initiatives, and provider submit carrier meetings developing key contacts and framing any responses to challenges and risks in accepting specific provider groups through the e-claims submissions channel.
- Support Senior Management as needed through program feedback, junior staff support, and report creation (both analytical and written)
What can we offer you?
- A competitive salary and benefits package.
- A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.
- A focus on growing your career path with us.
- Flexible work policies and strong work-life balance.
- Professional development and leadership opportunities.
Our commitment to you
- We lead with our Values everyday and bring them to life together.
- Values-first culture
- We create opportunities to learn and grow at every stage of your career.
- Boundless opportunity
- We invite you to help redefine the future of financial services.
- Boundless opportunity
- We foster an inclusive workplace where everyone thrives.
- Delivering the promise of Diversity, Equity and Inclusion
- We build a business that benefits all stakeholders and has a positive social and environmental impact.
- Championing Corporate Citizenship
#LI-HYBRID
About Manulife and John Hancock
Manulife Financial Corporation is a leading international financial services group that helps people make their decisions easier and lives better. With our global headquarters in Toronto, Canada, we operate as Manulife across our offices in Asia, Canada, and Europe, and primarily as John Hancock in the United States. We provide financial advice, insurance, and wealth and asset management solutions for individuals, groups and institutions. At the end of 2022, we had more than 40,000 employees, over 116,000 agents, and thousands of distribution partners, serving over 34 million customers. At the end of 2022, we had $1.3 trillion (US$1.0 trillion) in assets under management and administration, including total invested assets of $0.4 trillion (US $0.3 trillion), and segregated funds net assets of $0.3 trillion (US$0.3 trillion). We trade as MFC' on the Toronto, New York, and the Philippine stock exchanges, and under 945' in Hong Kong.
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
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
.
Salary & Benefits
The annual base salary for this role is listed below.
Primary Location
Salary range is expected to be between
If you are applying for this role outside of the primary location, please contact
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