Manager, Fraud Risk Management Disability

Job Description

Fraud management is increasingly important to Plan Sponsors. In order to serve Sun Life’s clients as industry leaders, Canadian Operations’ Fraud Risk Management area will support the Group Disability business by identifying, mitigating and responding to criminal threats using various tools, technologies, and strategies.

Reporting to the Director, Fraud Risk Management (FRM), the Manager, FRM Disability Program is accountable for day-to-day leadership of a team of Individual Member Investigators and Analysts responsible for fraud detection, prevention and investigations specializing in the Group Disability business.

The incumbent will contribute to the setting and prioritizing of operational and change initiatives to leverage existing processes, technologies, Extensive knowledge in investigations, investigative tools, privacy as well as legal

and our people to meet current and future business needs. The incumbent will also be accountable to develop business partnerships with areas that support the team and service delivery such as Group Life and Disability, Legal, Compliance, Group Benefits Customer Care Centre (GBCCC), Group Health & Dental (H&D) Claims, Business Development, and other FRM teams and partners.

With the need to continuously adapt and evolve to keep ahead of fraud trends and emerging schemes, the incumbent will be responsible for leading changes in partnership with areas that support the team and service delivery.

General Accountability and Scope :

• Provide day to day leadership to a team of specialized disability Investigators and Analysts to ensure effective delivery of a consistent service experience
• Lead and support direct reports in executing quality service delivery and support them by providing direction, setting clear expectations, providing support, coaching, recognition, and holding individuals accountable for results
• Conduct regular assessments on the quality of documentation, prioritization of investigations and decisions made on cases
• Develop the team’s competencies to fully utilize individual team members’ strengths and talents
• Develop the team’s knowledge of the Disability products and services to deliver high quality investigation strategies and relationships with Disability partners
• Build strong and credible relationships with Disability partners for implementation of fraud investigative findings
• Provide exceptional focus to processes and the timely delivery of reporting fraud cases and financial results
• Support the overall change agenda for FRM ensuring that all change is sustainable, champion a culture of continuous improvement and innovation to deliver on the ever-evolving expectations of our plan members, plan sponsors, Advisors and distribution partners
• Collaborate effectively with internal and external stakeholders
• Participate in projects involving new technologies, processes and practices
• Develop and maintain effective working relationships with internal and external customers, distribution partners and colleagues in the anti-fraud industry
• Monitor emerging trends in health care to identify potential risk of misuse or abuse of Group Benefit products
• Remain up to date on disability practices and strategies
• Remain up to date on fraud industry trends, products and privacy laws
• Participate in speaking engagements, presentations and meetings with clients, as required

Competencies :

• Bilingualism (French, English, both oral and written) is required as the position includes managing French and English-speaking staff (Quebec and outside Quebec) and providing daily support to the team.
• Minimum of 3-5 years’ experience leading a team focused on Disability management and / or Fraud and Abuse Management
• Strong knowledge of Group Disability business (products and disability management practices and processes)
• Extensive knowledge in investigations, investigative tools, privacy as well as legal aspects
• Knowledge of group insurance business (products, services, distribution, organization, systems, processes) and regulatory environment as well as Health and Dental claims management, Life benefits, Critical Illness, etc.
• Superior leadership skills, ability to influence solutions and facilitate cross-functional teamwork that meets the needs of the business strategy
• Excellent relationship and team building skills
• Strong analytical skills and critical thinking with attention to accuracy and details
• Excellent communication skills (written and verbal) and experience presenting sensitive matters to clients or senior management
• Proven presentation skills
• Solid decision-making skills by understanding and assessing business needs and risks
• Superior organizational skills and ability to multi-task, prioritize initiatives and execute effectively
• Ability to develop plans and to create change by challenging the status quo
• Ability to hold others accountable
• Advanced computer skills (Word, Excel, Lotus Notes, PowerPoint)

Assets :

University degree or postsecondary education in risk management, fraud and audit management, or related to disability management

Location & travel :

• This position is located in Montreal, Waterloo, Toronto
• Some travel to other Sun Life offices, to Plan Sponsor locations, and for various presentations will be required
• Overtime may be required to meet deadlines.
Il y a 6 jours