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About the Role

The Investigator is a key member of the health and dental team that delivers robust and effective health and dental claims fraud prevention to Canada Life customers. The main function of the Investigator is to conduct investigations by assessing case information and analytical aspects of the data and then contact providers and clinics to validate services to ensure that claims are free from suspicion of fraud/abuse. The IRS works closely with their leader in determining investigative next steps as well as other members of the teams including data analysts and members of Special Investigations. Taking into consideration the evidence and other information gathered, the Investigator will propose and execute recommendations regarding resolution, collaboration with special investigations, or recovery. The Investigator is responsible for ensuring that case documentation is accurate and complete and will write case reports as needed for senior leadership and clients.

Responsibilities

Conduct thorough investigations of assigned cases as identified through various detection sources.
Understand and interpret data from various detection sources by working closely with Analysts when required.
Develop and execute the investigative plan to obtain evidence where fraud is suspected by contacting (verbal and/or written) appropriate parties, including plan member, claimant and/or provider.
Document investigative actions and outcomes according to department policy.
Determine and execute the appropriate action according to established protocols where evidence supports an action.
Write client-facing reports regarding investigative findings and comprehensive reports when cases are referred to special investigations.
Communicate case information as necessary according to established protocols.
Identify fraud and abuse risks and make recommendations to mitigate future risk.
Maintain accurate methods of record keeping and statistics according to department policy.
Work on special projects as assigned.
Maintain appropriate professional development.
Live the values of Customer View; Integrity; Partnership; and Communities.

Requirements

Completion of post-secondary level education (eg: university or college degree/diploma).
Minimum two years related work experience in an adjudicative, investigative, and/or analytical field.
Experience in a Dental Clinic, Paramedical Clinic or Pharmacy would be an asset.
CFE designation would be considered an asset.
A combination of relevant experience and education will be considered.
Strong decision making, problem solving skills, and analytical skills.
Proven experience providing excellent customer service.
Excellent ability to communicate, both orally and in writing, in fast-paced and unscripted situations.
Excellent organizational and time management skills; able to handle multiple, simultaneous investigations.
Strong report writing skills.
Strong customer service orientation.
Claims knowledge would be considered an asset.
Understanding of Group Operations (including legacy systems)/Business knowledge would be an asset.
Demonstrated proficiency using Excel, Word and Access.
Reliability Status Security Clearance required as a condition of employment.
Bilingualism (fluent in French and English) required.

Skills

Communication skills
Problem solving skills
Organization skills
Decision making skills
Analytical skills
Customer service skills
Report writing skills
Time management skills
Excel proficiency
Word proficiency
Access proficiency

Location

Hybrid

Work Type

Permanent
Full Time

Experience Level

Minimum two years related work experience

Education Level

Post-secondary education (university or college degree/diploma)

Salary/Compensations

$41,100 - $68,400 annually

Benefits

Career Development opportunities
Access to industry-leading learning programs
Up to $2,000 annually towards education reimbursement
Flexible health and dental benefits
$5,000 mental health benefit
In addition to regular vacation and personal days
Volunteer day
Company-matching pension plan
Share ownership program
Additional investment options
Employee recognition programs
Service milestone celebrations
Employee discounts
Employee Resource Groups (ERGs)
Mentorship programs
Social clubs and events

About the Company

We are united by a shared purpose: to improve the financial, physical and mental well-being of Canadians.
Our company is trusted by 1 in 3 Canadians and contributes to the strength of communities across the country.
We’re looking for people who live our values everyday: we step up, do the right thing, and deliver – for our customers, communities and each other.

Equal Opportunity

We’re committed to removing barriers and ensuring equal access to employment. Applicants requiring reasonable accommodation during the application process may contact talentacquisitioncanada@canadalife.com. All information provided will be handled in accordance with applicable laws and Canada Life policies.
Canada Life would like to thank all applicants, however only those who qualify for an interview will be contacted.