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Kitchener

    Technical Investigator - Waterloo, ON, Canada - Sun Life Financial

    Sun Life Financial
    Sun Life Financial Waterloo, ON, Canada

    2 weeks ago

    Default job background
    Description

    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. Discover how you can make a difference in the lives of individuals, families and communities around the world.
    Fraud management is increasingly important to policy holders.

    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.

    Reporting to the Manager for Fraud Risk Management (FRM), the Investigator will be responsible for detecting, investigating, and preventing collusion schemes impacting the Canadian Group Benefits business.

    specifically medical service providers, Account Executives, Plan Sponsors and Plan Members, to deliver timely updates and outcomes.

    Using data analytics, advanced interviewing skills and investigative excellence, the successful candidate will largely focus on collusion schemes involving medical providers, facilities, and Plan Members.

    Investigate situations of fraud and/or abuse with a focus on medical providers and facilities
    Legal, Health & Dental Claims, Customer Care Center, Plan Sponsors, Account Executives, etc.
    Prepare and participate in court/complaint cases, including arbitration hearings, to resolve investigations
    Research, gather data, prepare and organize documentation for Plan Sponsors, police and management
    Perform desk and site audits of service providers and medical facilities
    Promote education and awareness to internal and external stakeholders related to fraud prevention
    Knowledge of group insurance business and regulatory environment
    Understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry
    Knowledge of medical terminology
    Solid decision-making skills and innovative thinking
    Ability to collect, evaluate and analyze open source intelligence
    Identify processes to mitigate fraud and/or abuse across benefit plans

    As this position is posted in several locations, we specify that bilingualism (French, English, both oral and written) is required for Quebec only for the frequent interactions with English and French-speaking colleagues or internal partners across Canada or worldwide.

    To see if you are eligible for this clearance, please review the Government of Canada website.
    Supportive working environment, culture of collaboration, high performance teams
    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.

    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.

    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.

    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 .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.

    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. Discover how you can make a difference in the lives of individuals, families and communities around the world.
    Fraud management is increasingly important to policy holders.

    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.

    Reporting to the Manager for Fraud Risk Management (FRM), the Investigator will be responsible for detecting, investigating, and preventing collusion schemes impacting the Canadian Group Benefits business.

    specifically medical service providers, Account Executives, Plan Sponsors and Plan Members, to deliver timely updates and outcomes.

    Using data analytics, advanced interviewing skills and investigative excellence, the successful candidate will largely focus on collusion schemes involving medical providers, facilities, and Plan Members.

    Investigate situations of fraud and/or abuse with a focus on medical providers and facilities
    Legal, Health & Dental Claims, Customer Care Center, Plan Sponsors, Account Executives, etc.
    Prepare and participate in court/complaint cases, including arbitration hearings, to resolve investigations
    Research, gather data, prepare and organize documentation for Plan Sponsors, police and management
    Perform desk and site audits of service providers and medical facilities
    Promote education and awareness to internal and external stakeholders related to fraud prevention
    Knowledge of group insurance business and regulatory environment
    Understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry
    Knowledge of medical terminology
    Solid decision-making skills and innovative thinking
    Ability to collect, evaluate and analyze open source intelligence
    Identify processes to mitigate fraud and/or abuse across benefit plans

    As this position is posted in several locations, we specify that bilingualism (French, English, both oral and written) is required for Quebec only for the frequent interactions with English and French-speaking colleagues or internal partners across Canada or worldwide.

    To see if you are eligible for this clearance, please review the Government of Canada website.
    Supportive working environment, culture of collaboration, high performance teams
    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.

    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.

    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.

    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 .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.



    Risk Management Posting End Date:
    Our supportive, flexible, and inclusive work environment is one where you – and your career – can thrive. Whatever your aspirations, collaborative leaders and colleagues are ready to help you learn, grow, and succeed.
    Our purpose is to help Clients achieve lifetime financial security and live healthier lives.

    As part of Sun Life's growing team, you have an impact on people in your community and around the world.

    Use data to drive bold actions. Be agile and pivot as we test and learn. At Sun Life, we're driving transformation, sustainability and innovation for our Clients, employees, partners, and communities.
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