Investigator, Fraud Risk Management Disability Program

Job Description

Fraud management is increasingly important to policyholders. In order to serve Sun Life’s clients as industry leaders, the Canadian Operations’ Fraud Risk Management area will identify, mitigate and respond to threats using various tools, technologies and strategies.

Reporting to the Fraud Risk Management (FRM) Disability Manager, the Investigator is responsible for conducting thorough investigations into situations involving possible misrepresentation, fraud, and abusive activities related to Group Benefits claims, with a primary focus on Disability files. This role requires a detail-oriented professional who can independently assess and investigate identified fraud leads while maintaining the highest standards of accuracy and confidentiality. The successful candidate will be responsible for gathering, organizing, and analyzing complex data to build thorough case files that document all aspects of each investigation.

What will you do?

• Conduct a formal investigation when there is suspected misrepresentation or alternate employment on a Disability claim.
• Engage in phone and email communication with plan sponsors, service providers, disability case managers and other third parties.
• Leverage advanced, open-source search techniques, data analytics tools, and digital investigation frameworks to support organizational objectives and inform strategic decision-making.
• Document findings utilizing technology platforms and formal reports
• Conduct phone interviews with plan members
• Prepare and deliver compelling presentations of investigative findings to internal stakeholders, across various levels.
• Engage in collaborative efforts between other FRM teams and Disability to identify and investigate claim misrepresentation or suspected fraud.
• Maintain accurate documentation of all case notes and findings in an internal case management system.
• Identify fraud trends and support data analytics solutions to mitigate the newly identified risk
• Remain current and up to date on industry trends / education / products / privacy laws / etc.
• Contribute to the ongoing evolvement of the Disability Investigations process.

What do you need to succeed?

Unique Requirements

Reliability Status  : As a condition of the role, the successful candidate must obtain a Government of Canada Reliability Status security clearance through Sun Life.

What’s in it for you?