Conduct a formal investigation when there is suspected misrepresentation or alternate employment on a Disability claim.
Engage in phone and email communication with plan sponsors, service providers, disability case managers and other third parties.
Leverage advanced, open-source search techniques, data analytics tools, and digital investigation frameworks to support organizational objectives and inform strategic decision-making.
Document findings utilizing technology platforms and formal reports
Conduct phone interviews with plan members
Prepare and deliver compelling presentations of investigative findings to internal stakeholders, across various levels.
Engage in collaborative efforts between other FRM teams and Disability to identify and investigate claim misrepresentation or suspected fraud.
Maintain accurate documentation of all case notes and findings in an internal case management system.
Identify fraud trends and support data analytics solutions to mitigate the newly identified risk.
Remain current and up to date on industry trends/education/products/privacy laws/etc.
Contribute to the ongoing evolvement of the Disability Investigations process.

Bilingualism (French, English, both oral and written) is required
Experience and formal training in investigations, preferably within insurance or group benefits
Formal interview training and/or experience
Exceptional OSINT research skills
Strong presentation and communication skills with experience utilizing Microsoft Teams
Experience preparing comprehensive report summaries of investigative findings
Ability to apply critical thinking and innovative approaches when analyzing investigative findings.
Knowledge and understanding of contractual language, administration guidelines, and provincial and federal legislation
Knowledge in Disability claims, including short and long-term claims and Group Benefits, an asset
Familiarity with medical terminology, an asset

Bilingual Investigator, Fraud Risk Management – Disability Program

Key skills