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 conclusions including the preparation of criminal and regulatory complaints
Conduct interviews with plan members, providers of service and others
Create written audits and other correspondence to plan members, providers of service and others
Engage, interact and consult 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

University degree or equivalent work experience
Knowledge of Group Benefits
Knowledge of the Canadian healthcare environment, service delivery model and regulation
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 data analysis skills with expertise using Excel and other data mining software
Demonstrate 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

Health insurance
Dental insurance
Mental health benefits
Vision insurance
Short
and long-term disability insurance
Life and AD&D insurance coverage
Adoption/surrogacy benefits
Wellness benefits
Employee/family assistance plans
Retirement savings plans (including pension and a global share ownership plan with employer matching contributions)
Financial education and counseling resources
Paid time off including holidays, vacation, personal, and sick days
Full range of statutory leaves of absence

Investigation Analyst

Key skills