Investigation Analyst – Provider Risk

Manulife’s Group Benefits Health and Dental Claims 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, claims abuse management and monitoring programs, fraud investigations, data analytics, and claims experience management. The effective management of health and dental claims experience is imperative to the success of the group benefits operations. 

The Investigation Analyst will draw on their in-depth analytical skills, investigative mindset, customer focus, group benefits background and understanding of the Canadian Healthcare environment/regulation to help manage ongoing priorities in the delivery of risk management.

A key focus of the Investigation Analyst is 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.  The role may liaise externally with industry contacts and vendors, and internally with Legal, Compliance, Advanced Analytics, Marketing, Customer Service, Client Relations, Ombudsman and the Field as needed.

This role reports to the Senior Manager, Fraud Risk Management, 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. 

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 conclusion 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

• Travel may be required for this role including the ability to work outside of core working hours

Required Qualifications:

• Knowledge of Group Benefits

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

• University degree or equivalent work experience

Preferred Qualifications:

• Bilingualism (English and French) is an asset. If the successful candidate is in Québec, proficiency in both languages will be required to support clients from various provinces outside of Quebec.

• CFE designation is an asset       

• 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  

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

• Demonstrated investigation skills with attention to detail  

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

• Organizational skills and the ability to manage multiple conflicting priorities

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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The role being advertised is an existing vacancy.

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 [email protected].

Referenced Salary Location

Salary range is expected to be between

Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance. 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. If you are applying for this role outside of the primary location, please contact [email protected] for the salary range for your location.

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 [email protected] for more information about U.S.-specific paid time off provisions.

We use data and analytics technologies, such as artificial intelligence (AI), and automated processing tools, to analyze and process the information you provide to us or third parties in the application process. For more information, please refer to our personal information collection statement.