Investigation Analyst – Provider Risk

Manulife's Group Benefits Health and Dental Claims Risk Management team focuses on digital claims risk management, fraud investigations, and data analytics to support key operational objectives. The Investigation Analyst – Provider Risk plays a crucial role in preventing, detecting, and investigating fraud and abuse among healthcare providers, implementing risk mitigation strategies to protect benefit plans.

This position involves collaboration with internal departments and external contacts, reporting to the Senior Manager, Fraud Risk Management, and is key to safeguarding plan sponsors and members from claims fraud. If you have an investigative spirit and strong analytical skills in the Canadian Health Care Industry, this role might be for you.

Position Responsibilities:

• Data Analysis and Investigation: Perform risk-based data profiling to identify trends and outliers, leading investigations to successful conclusions, including preparing criminal and regulatory complaints.

• Audit Leadership: Lead and support audit programs by coordinating, assessing, and making decisions on investigations, and conducting interviews with plan members and service providers.

• Communication and Reporting: Create written audits and correspondence for plan members and service providers, while engaging with internal and external stakeholders to ensure comprehensive investigation processes.

Required Qualifications:

• Knowledge of Group Benefits

• Knowledge of the Canadian healthcare environment, service delivery model and regulation     

• University degree or equivalent work experience

• CFE designation is an asset       

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

Preferred Qualifications:

• Strong research, problem-solving and decision-making skills 

• Ability to manage contentious interactions with various stakeholders 

• Excellent oral communication (both phone and face-to-face) and written communication skills  

• Intermediate or higher data analysis skills with expertise using Excel and other data mining software 

• Demonstrated investigation skills with attention to detail  

• Ability to be creative, critical and aggressive in managing audit and investigative activities

• Organizational skills and the ability to manage multiple conflicting priorities

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

Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance. 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. If you are applying for this role outside of the primary location, please contact [email protected] for the salary range for your location.

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.