Job Specifications
Permanent Full Time
We are looking for an Investigator – Detection, Prevention & Integrity Services, Workplace Solutions (DPIS).
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.
As an investigator, you must possess superior written and verbal communication, problem solving, and organization skills to ensure the accurate documentation of the investigation.
Due to the high profile of a number of our clients, a Federal Government Enhanced Screening is a job requirement and this will involve fingerprinting and a credit check. This is a personnel security status that is required before an employee can gain access to Protected B information, assets or work sites as outlined by the Government of Canada website.
What You Will Do
Conduct thorough investigations of assigned cases as identified through various detection sources.
The ability to 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.
Where evidence supports an action, determine and execute the appropriate action according to established protocols.
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.
Living the values of Customer View; Integrity; Partnership; and Communities.
What You Will Bring
Full bilingual proficiency (oral, written, and reading) in English and French is an asset.
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.
The base salary for this position is between $41,100 - $68,400 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.
Grow with Canada Life
We’re 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, we do the right thing, and we deliver – for our customers, communities and each other. Are you someone who always strives to do the right thing, who steps up
About the Company
At Canada Life, we're focused on improving the financial, physical and mental well-being of Canadians. Whether handling policy claims, help growing and protecting clients' retirement and investment savings, providing workplace mental health support for all employers or helping build stronger communities by investing in community projects, we are committed to putting the customer first in all that we do. That trust is built on the dedication, skill and energy of our employees and advisors and their commitment to our customers...
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