Permanent Full Time
As the Manager Investigations, you will be accountable for a team of investigators responsible for investigation of suspected plan member and provider Group Health & Dental claims fraud, manage key client communications and reporting of investigation and program results and outcomes, and contribute to Canada Life's overall mitigation of fraud risk for its Group Customers.
What you will do:- Cultivate and strengthen relationships with key clients; Understand client needs and partner with other Canada Life operational areas to deliver on objectives
- Represent Canada Life in client meetings acting as a subject matter expert for investigations and client reporting, showcasing results and program activities
- Manage the execution of investigations of suspected external Group Health & Dental claims fraud committed by plan members, providers, and those associated to the provision of healthcare services/supplies, prioritizing investigations against staff resources
- Ensures the team operations deliver on strategic objectives
- Ensure investigations are completed in a timely manner, are high-quality and accurate, and timely and insightful reporting on investigative outcomes is surfaced
- Work with other leaders of the Fraud Management team to innovate and expand the tactics employed to ensure investigations are effective and the team takes creative and evolving approaches in keeping with the changing risk landscape
- Participate in root cause analyses on cases of confirmed fraud, identify and support remediation and corrective action in conjunction with internal stakeholders and partners
- Communicate investigation results to internal stakeholders. Establish and maintain reporting and metrics to permit evaluation of the effectiveness of investigations.
- Participate on fraud risk initiatives, committees, and working groups across the organization and at industry.
- Stay current on industry, fraud, risk, legal and litigation trends
- Provide strong leadership; manage/oversee hiring, performance management, annual salary adjustments, training plans, development, mentoring and coaching of staff.
What You Will Bring:- Post-secondary education; justice studies or a related field an asset
- Certified Fraud Examiner (CFE) designation an asset
- 3+ years of leadership experience
- Experience in investigations, auditing, fraud examination, or leading investigation teams
- Proven leadership, relationship management, collaboration, critical thinking, problem-solving, and decision-making skills
- Strong interpersonal skills with the ability to build relationships, influence change, negotiate, and collaborate effectively with a broad range of stakeholders
- Excellent written and verbal communication skills, including experience preparing and delivering communications, interacting with clients and internal audiences, and delivering difficult messages when required
- Highly organized with exceptional attention to detail and accuracy; able to manage multiple priorities, adapt to changing demands, and meet deadlines in a fast-paced environment
- Strong analytical abilities with the aptitude to assess, understand, and deliver on complex investigations and reporting requirements
- Advanced proficiency in Microsoft Office applications, including Outlook, Excel, Word, and PowerPoint, with strong working knowledge of Excel
- Reliability Status Security Clearance - this can only be completed with candidates who receive an offer of employment. This is a personal security status that is required as a condition of employment before an employee can gain access to Protected B information, assets or work sites as outlined by the Government of Canada website. The cost of submitting these checks will be covered by Canada Life.
The base salary for this position is between
$102,000 - $152,000 annually. This represents base salary only and does not represent other variable compensation components of our total compensation ( i.e. annual bonus, commission etc). If you are selected to move forward in our recruitment process, your recruiter will be able to discuss additional details of our total rewards program with you.
Career opportunities will be open a minimum of 5 business days from the date of posting, closing dates will vary depending on the search activity. All applications received will be reviewed on a rolling basis.
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Requisition ID: 6380
Category: Claims Management
Location:
