Investigation Analyst - Analytics

The Group Benefits Health and Dental Claims Risk Management department is a diverse and dynamic team delivering a broad range of services in support of key operational objectives.  Our responsibilities include online claims risk management, claims abuse management and monitoring programs, fraud investigations, data analytics, and claims experience management. Effective management of health and dental claims experience is imperative to the success of group benefits operations.  

The Investigation Analyst, Analytics, will draw on their in-depth analytical skills, investigative mindset, customer focus, group benefits background and understanding of the Canadian Healthcare environment/regulation to help manage ongoing priorities in the delivery of analytics controls.  The role will review analytics program outputs to identify trends and key parties requiring investigation and will help facilitate communication between data science teams and business partners to identify and drive effective programs surrounding fraud awareness, detection, and deterrence.  The role may liaise externally with industry contacts and vendors, and internally with Legal, Compliance, Advanced Analytics, Marketing, Customer Service, Client Relations, Ombudsman and the Field as needed.       

This role reports to the Program Manager, Investigation Services, and helps to protect plan sponsors and members from the negative impacts of claims fraud.  This role is focused on risk detection, which is the foundation for our investigation programs and a vital part of claims risk management. 

A key function of the Investigation Analyst, Analytics role is reviewing analytics leads for claims of interest from all submission channels.  This role will proactively identify high risk trends, champion detection strategies, assess effectiveness of analytics outputs and take actions to improve our ability to protect Manulife benefit plans from fraud and abuse. 

Position Responsibilities:

• Support investigation work and case management where needed

• Perform risk-based data profiling and analysis to identify trends and outliers in various categories for further review and investigation 

• Support analytics programs; coordinating, assessing, and making decisions on the need for further investigations

• Assist as needed with the development of new tools and metrics, analytics programs and collaborations with data science partners and external data vendors.  

• Take action on analytics program results, enhance risk profile assessments, setting investigation framework resulting from the alerts, dialoguing with professional associations and regulatory colleges, industry peers and vendors, and collaborating/consulting on downstream investigations as needed

• Understand and maintain current knowledge of audit and investigative techniques, tools, software, and technology

Required Qualifications:

• University degree or equivalent work experience    

• Strong data analysis skills with expertise using Excel and other data mining software 

• Knowledge of Group Benefits

Preferred Qualifications:

• Strong data analysis skills with expertise using Excel and other data mining software 

• Knowledge of PowerBI, Tableau, PowerApps, and/or SQL, an asset.

• Demonstrate investigation skills with attention to detail  

• CFE designation is an asset 

• Knowledge of fraud and abuse risk, and techniques to manage risk 

• Strong research, problem solving and decision-making skills 

• Understanding of provider regulatory colleges and professional associations

• Demonstrated strong analytical and problem-solving skills   

• Ability to assess analytics programs for effectiveness and make recommendations for enhancements in an evolving environment

• Ability to apply critical thinking in the assessment, ranking, and solving complex data reviews and leads

• Skills and ability to analyze and organize data to support analysis and recommendations for efficiencies in case triage and review processes

• Exceptional time management and organizational skills.  Ability to manage multiple conflicting priorities in a fast-paced changing environment is essential.

When you join our team:

• We’ll empower you to learn and grow the career you want. 

• We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words. 

• As part of our global team, we’ll support you in shaping the future you want to see.

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About Manulife and John Hancock

Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit https://www.manulife.com/en/about/our-story.html.

Manulife is an Equal Opportunity Employer

At Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.

It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact [email protected].

Referenced Salary Location

Salary range is expected to be between

If you are applying for this role outside of the primary location, please contact [email protected] for the salary range for your location. The actual salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education/training. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.

Manulife offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans. We also offer eligible employees various retirement savings plans (including pension and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in Canada includes holidays, vacation, personal, and sick days, and we offer the full range of statutory leaves of absence. If you are applying for this role in the U.S., please contact [email protected] for more information about U.S.-specific paid time off provisions.