Investigation Analyst

Job Description The Group Benefits Health and Dental Claims Risk Management department is a diverse and dynamic team delivering a broad range of services in support of key operational objectives. Our responsibilities include online claims risk management, claims abuse management and monitoring programs, fraud investigations, data analytics, and claims experience management. The effective management of health and dental claims experience is imperative to the success of the group benefits operations. The Investigation Analyst will draw on their in-depth analytical skills, investigative mindset, customer focus, group benefits background and understanding of the Canadian Healthcare environment/regulation to help manage ongoing priorities in the delivery of analytics controls. The role will review analytics program outputs to identify trends and key parties requiring investigation and will help facilitate communication between data science teams and business partners to identify and drive effective programs surrounding fraud awareness, detection, and deterrence. The role may liaise externally with industry contacts and vendors, and internally with Legal, Compliance, Advanced Analytics, Marketing, Customer Service, Client Relations, Ombudsman and the Field as needed. ResponsibilitiesPerform risk-based data profiling and analysis to identify trends and outliers in various categories for further review and investigation Support analytics programs; coordinating, assessing, and making decisions on the need for further investigationsAssist as needed with the development of new tools and metrics, analytics programs and collaborations with data science partners and external data vendors. Take action on analytics program results, enhancing risk profile assessments, setting investigation framework resulting from the alerts, dialoguing with professional associations and regulatory colleges, industry peers and vendors, and collaborating/consulting on downstream investigations as neededUnderstand and maintain current knowledge of audit and investigative techniques, tools, software, and technologyHow will you create impact? This role reports to the Program Manager, Investigation Services, and helps to protect plan sponsors and members from the negative impacts of claims fraud. This role is focused on risk detection, which is the foundation for our investigation programs and a vital part of claims risk management. A key function of the Investigation Analyst, Analytics role is reviewing analytics leads for claims of interest from all submission channels. This role will proactively identify high risk trends, champion detection strategies, assess effectiveness of analytics outputs and take actions to improve our ability to protect Manulife benefit plans from fraud and abuse. What motivates you? You obsess about customers, listen, engage and act for their benefit.You think big, with curiosity to discover ways to use your agile approach and enable business outcomes.You thrive in teams and enjoy getting things done together.You take ownership and build solutions, focusing on what matters. You do what is right, work with integrity and speak up.You share your humanity, helping us build a diverse and inclusive work environment for everyoneWhat we are looking forKnowledge of Group BenefitsStrong data analysis skills with expertise using Excel and other data mining software Knowledge of PowerBI, Tableau, PowerApps, and/or SQL as an asset.Demonstrated investigation skills with attention to detail University degree or equivalent work experience CFE designation is an asset Knowledge of fraud and abuse risk, and techniques to manage risk Strong research, problem-solving and decision-making skills Understanding of provider regulatory colleges and professional associationsDemonstrated strong analytical and problem-solving skills Ability to assess analytics programs for effectiveness and make recommendations for enhancements in an evolving environmentAbility to apply critical thinking in the assessment, ranking, and solving of complex data reviews and leadsSkills and ability to analyze and organize data to support analysis and recommendations for efficiencies in case triage and review processesExceptional time management and organizational skills. The ability to manage multiple conflicting priorities in a fast-paced changing environment is essential.Bilingual (French & English) will be considered as an assetWhat can we offer you? A competitive salary and benefits package.A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.A focus on growing your career path with us.Flexible work policies and strong work-life balance.Professional development and leadership opportunities.Our commitment to youValues-first culture: We lead with our Values every day and bring them to life together.Boundless opportunity: We create opportunities to learn and grow at every stage of your career.Boundless opportunity: We invite you to help redefine the future of financial services.Delivering the promise of Diversity, Equity and Inclusion: We foster an inclusive workplace where everyone thrives.Championing Corporate Citizenship: We build a business that benefits all stakeholders and has a positive social and environmental impact.#LI-HYBRIDAbout Manulife and John HancockManulife Financial Corporation is a leading international financial services group that helps people make their decisions easier and lives better. With our global headquarters in Toronto, Canada, we operate as Manulife across our offices in Asia, Canada, and Europe, and primarily as John Hancock in the United States. We provide financial advice, insurance, and wealth and asset management solutions for individuals, groups and institutions. At the end of 2022, we had more than 40,000 employees, over 116,000 agents, and thousands of distribution partners, serving over 34 million customers. At the end of 2022, we had $1.3 trillion (US$1.0 trillion) in assets under management and administration, including total invested assets of $0.4 trillion (US $0.3 trillion), and segregated funds net assets of $0.3 trillion (US$0.3 trillion). We trade as ‘MFC’ on the Toronto, New York, and the Philippine stock exchanges, and under ‘945’ in Hong Kong.Manulife is an Equal Opportunity EmployerAt Manulife/JohnHancock, we embrace our diversity. We strive to attract,developandretaina workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin,colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.It is our priority to remove barriers toprovideequal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent withapplicable laws and Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact