About this role
Role Overview
- Investigate situations of fraud and/or abuse with a focus on medical providers and facilities
- Conduct plan member and service provider interviews
- Respond to inquiries and escalations
- Maintain all databases and logs pertaining to Investigations
- Prepare and participate in court/complaint cases to resolve investigations
- Research, gather data, prepare and organize documentation for plan sponsors, police and management
- Identify trends, report on issues and suggest appropriate actions to both internal and external clients
- Perform on-site audits of service providers.
Requirements
- Previous audit / investigation / banking and interviewing experience
- 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
- University degree or postsecondary education is an asset
- Bilingualism (French, English, both oral and written) is required for Quebec only.
Benefits
- Access to short-term 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 self-care or care of others (i.e., family or others you may support) and Sick Days to support your well-being.