Dental Jobs in Cote-Saint-Luc, QC

Job Description

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

Reporting to the Manger for Fraud Risk Management (FRM), theDental Investigatorwill be responsible for fraud detection, prevention, and investigation into extended health care benefits fraud across Canada. Using data analytics, advanced interviewing skills and investigative excellence, the successful candidate will focus on the identification and investigation of situations involving dishonest, fraudulent, and abusive claiming involving dental providers, clinics, and plan members.

Investigations require regular contact with external stakeholders including plan members, dental providers, associations, and colleges. The Dental Investigator will be required to present findings, file regulatory complaints, prepare police cases, and give evidence at regulatory, civil and / or judicial hearings.

What will you do?

Identify high-risk areas of fraud and abuse in the dental landscape and make recommendations to address control gaps and continuous improvement.

Investigate situations of fraud and / or abuse with a focus on dental providers, clinics, and plan members.

Identify trends, report on issues and suggest appropriate actions to internal and external stakeholders.

Conduct plan member and provider interviews.

Make quick-thinking and decisive decisions when handling files.

Prepare documentation, such as investigation reports, management briefings, or other communications in a professional, confident and proficient manner.

Research, gather data, and present findings in a variety of settings and to a variety of internal and external stakeholders, including clients, service providers, Legal, internal business partners and senior management.

Prepare for and participate in regulatory, civil and / or judicial hearings to resolve investigations.

Keep up to date on industry trends and schemes impacting benefit plans.

What do you need to succeed?

Minimum of two years dental industry expertise attained through experience as a dental hygienist, dental assistant, dental office manager, or other related profession.

Strong knowledge of dental terminology and expense codes.

Knowledge of dental insurance benefits and regulatory environments.

Understanding of interviewing and investigative principles and practices.

Strong research and analysis skills.

Understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry.

Strong decision-making skills and innovative thinking.

Ability to effectively negotiate and influence.

Adaptable to a fast-paced environment and can work well independently and collaboratively.

Strong analytical skills with attention to accuracy and details.

Advanced Microsoft Office skills (Word, Excel, PowerPoint, Outlook), specifically Excel (experience with pivot tables)

As this position is posted in several locations, we specify that bilingualism (French, English, both oral and written) is required for Quebec only for the frequent interactions with English and French-speaking colleagues or internal partners across Canada or worldwide.

Preferred Skills :

Previous dental audit / investigation / interviewing experience.

University degree or post-secondary education is an asset.

Experience with Tableau is an asset

Unique requirements :

This position can be based in Montreal, Waterloo or Toronto with occasional travel.

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?

Hybrid work environment

A friendly, collaborative, and inclusive culture

15 vacation days per year

Flexible Benefits from the day you join to meet the needs of you and your family

Pension, stock and savings programs to help build and enhance your future financial security

The opportunity to move along a variety of career paths with amazing networking potential

Access to our Global Learning Centre, available 24 / 7 for your learning needs

Wellness programs that support the three pillars of your health – mental, physical and financial