Impress employers and recruiters.
Choose from hundreds of resume examples.

Impress employers and recruiters.
Choose from hundreds of resume examples.

Target Resume Now

About the Role

This role focuses on strengthening the Long-Term Care (LTC) Fraud, Waste & Abuse (FWA) program by analyzing claims and operational data to support investigations, identify fraud trends, and enhance processes and controls.

Responsibilities

• Lead targeted customer outreach to explain updated claim reimbursement controls, drive adoption, and support understanding and compliance.
• Conduct customer outreach via phone (approximately 60% of the role) related to claim reimbursement controls, education, and support.
• Analyze LTC claims and provider billing patterns to identify potential fraud, waste, and abuse.
• Prepare data extracts, dashboards, and concise analytic summaries to support case development and investigations.
• Monitor and communicate emerging fraud schemes, and assist in designing mitigations, controls, and process improvements.
• Partner cross-functionally with investigators, clinical teams, and technology teams to improve fraud operations and detection capabilities.
• Gather and document business needs (requirements, user stories, process flows) for enhancements to fraud detection and case management tools.
• Support performance monitoring and reporting for the LTC FWA program and contribute to continuous improvement across fraud operations.

Requirements

• 3–5 years of experience in Long-Term Care (LTC), healthcare/insurance business analysis, and/or Fraud, Waste & Abuse (FWA).
• Strong analytical and critical-thinking skills; able to interpret complex claims and operational data.
• Ability to translate findings into clear artifacts (business requirements, user stories, process flows).
• Advanced Excel skills and comfort with large datasets.
• Familiarity with SQL/SAS and/or BI tools (Power BI/Tableau) is a plus.
• Clear written and verbal communication skills; able to work effectively with both technical and non-technical stakeholders while managing multiple priorities.
• Experience with fraud investigations/SIU and familiarity with Medicaid and/or commercial LTC benefits and fraud/case management tools is preferred.

Skills

• Long-Term Care (LTC)
• Fraud, Waste & Abuse (FWA)
• Claims analysis
• Operational data analysis
• Customer outreach
• Data extraction
• Dashboard creation
• Analytic summarization
• Business requirements documentation
• User story creation
• Process flow documentation
• Advanced Excel
• SQL
• SAS
• Power BI
• Tableau
• Fraud investigations
• Medicaid
• Commercial LTC benefits
• Case management tools

Location

• USA, Massachusetts
• Remote

Work Type

• Full Time
• Remote

Experience Level

• 3-5 years

Salary/Compensations

• $73,350.00 USD - $122,250.00 USD

Benefits

• Opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.
• Health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage.
• Adoption/surrogacy and wellness benefits.
• Employee/family assistance plans.
• Retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions).
• Financial education and counseling resources.
• Up to 11 paid holidays, 3 personal days, 150 hours of vacation, and 40 hours of sick time (or more where required by law) each year.
• Full range of statutory leaves of absence.

About the Company

• Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better.
• Manulife's ambition is to be the સૌથી digital, customer-centric global company in its industry.
• John Hancock Life Insurance Company (U.S.A.) is part of Manulife.
• Manulife is committed to investing in digital innovation and accelerating a sustainable and economically inclusive future.
• Manulife is proud of its accomplishments and recognitions, including the 2024 Gallup Exceptional Workplace Award, being named one of Forbes World’s Best Employers 2023, Best Companies to Work for in Asia 2023, one of Canada’s Top 100 Employers (2024), and inclusion in Bloomberg’s 2023 Gender-Equality Index.

Equal Opportunity

• Manulife is an Equal Opportunity Employer.
• Manulife/John Hancock embraces diversity and strives to attract, develop, and retain a diverse workforce.
• Fosters an inclusive work environment that embraces the strength of cultures and individuals.
• Committed to fair recruitment, retention, advancement, and compensation without discrimination based on protected characteristics.
• Prioritizes removing barriers to provide equal access to employment.
• Human Resources representatives will work with applicants who request a reasonable accommodation during the application process.
• Information shared during the accommodation request process will be stored and used in a manner consistent with applicable laws and Manulife/John Hancock policies.
• Know Your Rights I Family & Medical Leave I Employee Polygraph Protection I Right to Work I E-Verify