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 Manager for Fraud Risk Management, the Bilingual Investigative Analyst will work in partnership with Investigators in the identification and investigation of situations involving suspected dishonest, fraudulent and abusive claiming activities pertaining to dental service providers, clinics and plan members.
Applying attention to detail and quick decision-making, the successful candidate will complete several daily tasks, largely focusing on reviewing dental claims for flags representing unusual claiming situations and performing audits. The successful incumbent will collaborate across teams in the prevention and detection of fraud and abuse within the dental landscape.
Main accountabilities:
Conduct reviews of plan member and service provider claiming behavior to rule out fraud or abuse.
Using data analysis and audit outcomes, recommend dental providers and clinics for investigation.
Identify, track and communicate emerging fraud and abuse trends.
Triage tips and referrals related to inappropriate administration practices of dental providers.
Provide support to the Investigator on active profiling of dental providers.
Assist in interviewing plan members and prepare packages for onsite audits.
Timely collection and documentation of investigative steps and outcomes
Action and respond to inquiries and escalations.
Confidently communicate audit findings to a variety of audiences including plan members, service providers and management.
Assist in the preparation of delist recommendations, regulatory complaints and criminal briefs.
Promote education and awareness to internal and external stakeholders related to fraud prevention.
Make recommendations for continuous improvement.
Keep up to date on trends and schemes impacting benefit plans.
Competencies:
Bilingualism (French, English, both oral and written) is required for the frequent interactions with English and French-speaking colleagues or internal partners across Canada and worldwide.
Minimum of two years dental industry expertise attained through experience working in a dental office.
Excellent communications skills both verbal and written.
Strong knowledge of dental benefits and dental terminology.
Needs to be able to work independently within a fast-paced environment and participate in opportunities to share and learn through group collaboration.
Knowledge and understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry.
Strong decision-making skills and attention to detail.
Advanced computer skills (Word, Excel, Tableau, Outlook)
Assets:
Experience working within audit or investigations.
University degree or postsecondary education.
Why join Sun Life:
Being a member of the Sun Life family, a group of people united by our Purpose: to help Clients and Employees achieve lifetime financial security and live healthier lives
A friendly, collaborative and inclusive culture
A collaborative and interactive team environment
Being part of our journey in developing the next greatest digital experience
Working together, sharing common values and encouraging growth & achievement
Reliability Status
Must be able to obtain Reliability Status through the Government of Canada before a start date can be confirmed (includes a background check with fingerprinting by the RCMP).
Bilingual Investigative Analyst - Fraud Risk Management • Sun Life Montreal Metcalfe
Become a key player in shaping fraud strategies as a Senior Fraud Analyst.Utilize your analytical strengths and customer-centric approach in a remote capacity to combat financial crime effectively.... Show more
A career in our Financial Services Risk and Regulatory (FS R&R) Credit Risk Modelling practice will provide you with the opportunity to help financial institutions rethink their approach to risk by... Show more
A global trading firm is seeking a cybersecurity professional in Montreal to join their team.You will play a key role in detecting threats, responding to incidents, and improving security measures.... Show more
Model development, validation and implementation of Retail and Wholesale credit risk methodologies including obligor and facility risk rating, Basel regulatory capital and economic capital models, ... Show more
Our founding team has built and shipped digital products at Canada's leading financial institutions—and now we're doing it faster, bolder, and entirely on our own terms.We're growing quickly and lo... Show more
BET99 is Canada's Premiere Online Sportsbook and Casino.Launched in 2020, we have consistently innovated the online gaming landscape every step of the way, exponentially growing our customer base a... Show more
Credit Risk Modelling Senior Associate (Bilingual FR/EN).Be among the first 25 applicants.Get AI-powered advice on this job and more exclusive features.A career in our Financial Services Risk and R... Show more
Looking for people to participate in taking online surveys for Fortune 500 brands.All you need to do is complete online surveys by sharing your opinion.You will help influence brand decisions on se... Show more
Communicate with clients as the.Archive all programming deliverables and documentation per SOPs.Mentor team members and support their technical and professional development.CDISC standards, and com... Show more
Maximize fraud detection efficiency as a Bilingual Analyst in the Special Investigations Unit.Harness your analytical prowess in English and French to identify and analyze suspicious claims.The Ana... Show more
As the founding entity of RAINBOW PARTNERS, Quanteam is a consulting firm specializing in Banking, Finance, and Financial Services.Guided by our core values of closeness, teamwork, diversity, and e... Show more
Shape cybersecurity efforts as a Senior SOC Analyst, proficient in threat detection and incident response.Lead remote operations to tackle complex security challenges while mentoring junior analyst... Show more
A consulting firm specializing in finance is hiring a Software Asset Management (SAM) Analyst for an investment bank in Montreal.The role involves ensuring software license compliance, maintaining ... Show more
Insight Global is looking for a Fraud Analyst to join a large banking client on a 6-month contract fully remote across Canada working EST hours.The successful candidate will join a team of fraud an... Show more
We’re one of Canada’s largest pension investors, with CAD$299.We invest funds for the pension plans of the federal public service, the Canadian Forces, the Royal Canadian Mounted Police, and the Re... Show more
Take on a critical role as a Senior Bilingual Analyst in the Special Investigations Unit at Echelon Insurance.Focus on developing fraud detection strategies and ensuring compliance in a collaborati... Show more
Our Krakenites are a world-class team with crypto conviction, united by our desire to discover and unlock the potential of crypto and blockchain technology.Kraken is a mission-focused company roote... Show more
A banking services provider is seeking a Compliance Analyst in Montreal.You will review communications for adherence to rules, detect suspicious activities, and assist in risk management efforts.Th... Show more
We’re one of Canada’s largest pension investors, with CAD$299.We invest funds for the pension plans of the federal public service, the Canadian Forces, the Royal Canadian Mounted Police and the Res... Show more
Advance Alteo's cybersecurity framework as a SOC & Compliance Analyst in Montreal.Your mission will focus on incident response and ensuring compliance with security regulations.In this permanent po... Show more
){kind=logo}
){kind=logo}
%20group){kind=logo}
