Bilingual Claims Verification Analyst - Maisonneuve, Canada - Manulife

Manulife

Verified Company

Maisonneuve, Canada

3 weeks ago

Posted by:

Sophia Lee

beBee Recruiter

Description

_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
Hybrid

The Bilingual Claims Verification Analyst is responsible for supporting health and dental claims fraud risk controls by authenticating claim submissions, identifying, and investigating issues for action and resolution, and escalating key control issues to the claims risk management team.

The Bilingual Analyst will conduct health and dental claims audits through reviewing receipt evidence and supporting documentation, contacting providers and/or plan members to validate submissions, verify provider licensing through internet searches and contact with professional associations and colleges, and follow through on actions from these reviews for successful outcomes.

The auditor will work with our various internal departments including Technical Services, Customer Service, Investigation Services and H&D Operations for resolution on claims submission issues.

Responsibilities

Reviews audit evidence submissions by plan members to authenticate information, identifies areas of concern, actions issues for resolution, and obtains/requests additional evidence required on suspect claim submissions.
Validates irregular Internet transaction activity through phone call interviews with providers and/or plan members and secures evidence on discrepancies as part of information gathering on suspect claim submission activity. Requests supporting documentation from plan members and authenticates information, identifying issues and gaps for further review and resolution.
Identifies fraudulent claims, documents and gathers evidence, and supports ongoing management of investigation activity
Confirms provider licensing credentials and legitimate business establishments through Internet searches and by contact with professional associations and colleges. Actions and resolves issues for successful audit outcomes and escalates key provider control issues to the ecommerce control management team
Analyzes data to identify anomalies, trends and patterns; and supports testing, and documentation of new risk controls for continuous review of all Internet submission activity
Supports awareness on ecommerce control and operational workflow issues by providing direction and information to internal Group Benefit departments such as Call Center and various Health and Dental Operation departments

How will you create impact?

The Claims Verification Analyst reports to the Program Manager, Investigation Services, and helps to protect plan sponsors and members from the negative impacts of claims fraud.

This role is focused on risk detection, which is the foundation for our investigation programs and a vital part of claims risk management.

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

Bilingualism (French and English) is required
Ability to manage contentious interactions with various stakeholders and take control of stressful situations with tact and diplomacy
Excellent oral communication skills and ability to interview service providers, plan members and others for successful audit outcomes
Excellent written communication skills
Resourceful with a proven analytical, problem solving, and troubleshooting background
Proficient in research and quick decision making
Knowledge of privacy, civil and criminal legal risks, and processes
Strong organizational skills and the ability to manage multiple conflicting priorities in a fastpaced changing environment as well as adapt to changes is essential
Ability to takeaction on ideas, situations, or opportunities before being asked
Ability to be skeptical, probing, creative and aggressive in conducting authentication and investigation activity

What can we offer you?

A competitive salary and benefits packages.
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 worklife balance.
Professional development and leaders