Bilingual Investigator - Toronto, Canada - Sun Life

Sun Life

Verified Company

Toronto, Canada

1 week ago

Posted by:

Sophia Lee

beBee Recruiter

Description

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.

Fraud management is increasingly important to policyholders.

In order to serve Sun Life's clients as industry leaders, the Canadian Operations' Fraud Risk Management (FRM) area will identify, mitigate and respond to criminal threats using various tools, technologies and strategies.

Reporting to the Fraud Risk Management (FRM) Member Investigations Manager, the Investigator will investigate situations involving possible dishonest, fraudulent, and/or abusive activities related to Group Benefits claims.

The role includes investigating cases of fraud and abuse, filing regulatory complaints, preparing police cases, conducting interviews and timely communication with various internal and external stakeholders.

The role requires an incumbent who is enthusiastic and thrives in a fast paced and changing work environment.

What will you do?

Conduct a formal inquiry when fraudulent Medical or Dental claims, or related dishonest activity, is suspected
Conduct interviews and take statements from claimants, plan sponsors, service providers and other third parties
Assist in coordinating efforts between FRM and other Sun Life business areas where applicable to identify and investigate claims fraud and plan abuse
Conduct policy and certificate reviews
Maintain case documentation and evidence
Prepare/contribute to reports for trends analysis
Identify fraud trends and support data analytics solutions to mitigate the newly identified risk
Provide assistance to resolve allegations of fraud
Provide investigative expertise and related reporting on cases to FRM management, the Ombudsman, Business Development, Customer Care Centre, and other pertinent internal and external stakeholders
Prepare and file regulatory complaints
Prepare and support police cases to law enforcement
Assist in the detection and prevention of fraud and abuse
Train internal and external stakeholders on ways to prevent fraud and abuse
Remain current and up to date on industry trends/education/products/privacy laws/etc.

What do you need to succeed?

Strong knowledge of Group Benefits products,
Interviewing skills
Research and analysis
Knowledge of medical terminology
Previous Investigation experience within the Health and Dental Benefits area and/or within the medical industry is an asset
Exceptional communications skills both verbal and written
Knowledge and understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry
Strong decision making and negotiation skills
Excellent PC skills (Word, Excel, Power Point, Access)
Direct or indirect experience as a medical practitioner is an asset
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 Frenchspeaking colleagues or internal partners across Canada or worldwide.
University degree is an asset

What's in it for you?

We're proud to be recognized as a company with a 2023 Most Trusted Executive team by Great Place to Work Canada
Access to shortterm assignments or 'Gigs' across the organization, to help you develop new skills and connections.
A collaborative and interactive team environment
Charitable giving through our You Give, We Give program lets you give back to your community and in many cases, we'll match your contributions.
Care Days available for selfcare or care of others (i.e., family or others you may support) and Sick Days to support your wellbeing.

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.

Salary Range:

54,300/ ,300/88 300

Job Category:

Risk Management

Posting End Date:

22/03/2024