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About the Role
The Investigator is a key member of the Medical and Dental Claims team, providing robust and efficient fraud prevention services for medical and dental claims to Canada Life clients. The primary function is to conduct investigations by evaluating information on a file, considering data analytics, and communicating with providers and clinics to confirm services and ensure no suspected fraud or abuse is present on submitted claims. The Investigator works closely with their leader to determine next steps and with members of other teams, including data analysts and special investigation unit members. Based on evidence and gathered information, the Investigator presents and implements recommendations for file resolution, collaboration with the special investigations unit, or recovery. They ensure supporting documentation is accurate and complete, and prepare reports for senior management and clients as needed.
Responsibilities
- Conduct comprehensive investigations on assigned files using various detection sources.
- Understand and interpret data from various detection sources, working closely with analysts as needed.
- Develop and implement the investigation plan to obtain evidence when fraud is suspected by communicating (verbally or in writing) with affected parties, including plan members, claimants, and providers, as applicable.
- Document investigation steps and findings in accordance with team policy.
- If evidence warrants, determine and implement appropriate actions in accordance with established protocols.
- Prepare reports for clients on investigation findings and comprehensive reports when a file is referred to the special investigations unit.
- Communicate file information in accordance with established protocols, as needed.
- Identify risks of fraud and abuse and make recommendations to mitigate future risks.
- Utilize accurate statistical and record-keeping methods, in line with team policies.
- Handle assigned special projects.
- Pursue professional development.
- Embody our values: customer insight, integrity, partnership, and communities.
Requirements
- Post-secondary diploma or certificate (university, college, CEGEP).
- Minimum of two years of professional experience in assessments, investigations, or analysis.
- Experience in a dental office, paramedical clinic, or pharmacy is an asset.
- CFE designation is an asset.
- Relevant combination of experience and training will be considered.
- Superior decision-making, problem-solving, and analytical skills.
- Proven ability to deliver excellent customer service.
- Excellent ability to communicate orally and in writing in rapidly evolving, unforeseen situations.
- Strong organizational and time management skills; ability to manage multiple investigations simultaneously.
- Report writing aptitude.
- Strong commitment to serving customers well.
- Knowledge of claims processing is an asset.
- Understanding of Group Business operations (including legacy systems) / business knowledge is an asset.
- Proven skills in using Excel, Word, and Access.
- Reliability Status and Security Clearance - Only candidates who have received a job offer can undergo these checks. This is a personal security clearance required as a condition of employment. It must be obtained before an employee can access Protected B level information, assets, or workplaces, as indicated on the Government of Canada website. Canada Life will cover the costs associated with these checks.
- Bilingualism is an asset (fluency in French and English), but is only required for Quebec, as the incumbent will regularly serve our French and English-speaking clients.
Skills
- Bilingualism (French and English)
- Excel
- Word
- Access
Location
- Remote
- Hybrid
Work Type
- Permanent
- Full-time
Experience Level
- Minimum of two years of professional experience
Education Level
- Post-secondary diploma or certificate (university, college, CEGEP)
Salary/Compensations
- $41,100 - $68,400 per year
Benefits
- Professional development opportunities
- Access to leading learning programs
- Tuition reimbursement up to $2,000 annually
- Flexible medical and dental coverage
- Mental health care coverage of $5,000
- Paid time off for volunteering
- Pension plan with employer matching contributions
- Share purchase plan
- Other investment options
- Recognition programs
- Employee discounts
- Celebration of significant service anniversaries
- Employee Resource Groups (ERGs)
- Mentorship programs
- Social committees
- Various events
About the Company
- Guided by our mission to improve the financial, physical, and mental well-being of Canadians.
- A trusted company for 1 in 3 Canadians.
- Contributes to building stronger communities across the country.
- Looking for individuals who embody our values daily: take action, do what's right, and be up for the challenge – for the benefit of our customers, communities, and teams.
Equal Opportunity
- Committed to providing equitable access to employment by removing barriers.
- Individuals requiring reasonable accommodation during the recruitment process can email talentacquisitioncanada@canadavie.com.
- All information provided will be handled in accordance with applicable laws and Canada Life policies.