INVESTIGATIVE ANALYST (HYBRID)

WHO WE ARE

When it comes to health, we’re always looking for waysto push for better. It’s why we were founded in the first place. In 1957, ourfounder, pharmacist William Wilkinson, witnessed a mother sacrifice her healthby forgoing her own medicine to pay for her sick daughter’s prescription. Heknew there had to be a better way. So, he introduced North America’s firstprepaid drug plan, and GreenShield was born as a not-for-profit with a missionto support better health for all Canadians.

We aren’t just a health and benefits company. We’rethe only not-for-profit social enterprise that brings worlds of coverage andcare together, all in one place.

We’re noble challengers, purposefully building a betterway and we need the best people to help us create a more holistic approach thattakes care of the mind and body.

Our mission is to create better health for allCanadians, and we know that starts with our employees.

THEROLE IN A NUTSHELL

Base Salary: CAD $59,688.00 - 91,109.00

This role reports to the Supervisor, ClaimWatch.

• Identify, research, and analyze areas of abuse, misuse and fraudulent claims activity from Providers and Plan Members.
• Conduct interviews and act as an undercover agent (mystery shopper).
• Communicating regularly with both internal and external stakeholders.
• Research trends in benefit utilization.
• Develop profiling criteria.
• Identify and make recommendations on -fraud mitigation opportunities.
• Work directly with stakeholders, various medical providers and governing bodies, law enforcement, etc.
• Build summary reports of findings and present conclusions and recommendations as required

WHO WE'RE LOOKING FOR

• Minimum of 3 years’ experience in audit and fraud detection, health care benefit administration, healthcare field and/or conducting investigations.
• A university degree or diploma in a related discipline or equivalent work experience.
• Established analytical, complex problem solving, and decision‑making skills.
• Expertise in online fraud analysis. Ability to identify fraud indicators in electronic and online benefit claims, including suspicious behaviors related to the use of digital platforms.
• Experience in detecting fraudulent online activities, including the collection and analysis of digital evidence and the investigation of electronic fraud incidents.
• Working knowledge of relevant federal and provincial legislation, regulations and the judiciary system (Including but not limited to: PIPEDA, Regulated Health Professions Act, Privacy Act) would be an asset.
• Strong computer skills, with an ability to develop and craft reports including validation of these reports.
• Extraordinary consultation and negotiation skills.
• Strong interpersonal skills and the ability to communicate to all levels of internal and external customers both oral and written.
• Able to work in an independent work environment as well as in a team.
• Strong attention to detail, time management and organizational skills with tight deadlines and changing priorities\

NICE TO HAVE

• Bilingual (English and French).
• Private Investigator license, issued by the appropriate body.
• A Certified Fraud Examiner (CFE) certificate.
• A Certified Anti-Money Laundering Specialist (CAMS) certificate

THE CULTURE

We believe a career should be meaningful. Not just ameans to earn a living. Our culture is one where everyone's voice is heard andvalued. Because that’s what it takesto create better health for all. We dare to challenge the status quo. And we’redriven by people who have challenged theirs. We believe that yourworkplace should empower you to be the best version of yourself. That’s why we provide aplace where you can be inspired, challenged, and rewarded.

Where your growth means our growth.

Where your voice is heard and valued.

Where your work has purpose. And purpose matters.

We believe our people arecritical to our overall success. Inclusivity makes us a stronger, smarter andmore informed organization. Being intentionally inclusive of diversebackgrounds, perspectives and experiences will enhance our company culture topositively impact how we support our communities. A career at GreenShield isn’t just about personalachievements, it's about making adifference together.

Here’s to Better Health for All!

AFEW MORE DETAILS

Proficiency in English is requiredfor this position. As part of this role, you will be required to communicatewith colleagues or customers who use English as their primary language. By requiring English proficiency for thisposition, we aim to ensure that our employees can excel in their roles,collaborate, and communicate effectively, and contribute to the success of ourorganization.

GS supports diversity, equity andinclusion in our teams and communities, and we value the unique contributionsmade by all. Even if your experience doesn’t align perfectly to everyrequirement, we invite you to apply. We encourage applications fromall candidates and will accommodate needs under human rights legislationthroughout all stages of the recruitment and selection process. Please let usknow of any accommodation through requestforaccommodation@greenshield.ca. Information received relating toaccommodation will be addressed confidentially.

Providing this information givesGS consent to use your personal information to assess your suitability forspecific positions, future opportunities or for your personnel file. Yourrésumé will be held in strict confidence and will be viewed only by theOrganization. Information may be stored outside of Canada and could be used foraggregate statistical purposes (which uses no personal identification).

AI Usage - GreenShield leverages AI to help produce Job Descriptions, and ideate on interview questions. We also leverage AI for interview transcription support.