Bilingual Investigative Analyst - Fraud Risk Management
Sun Life Montreal Metcalfe, Canada
CAD 58K-93K (estimate) Senior-level Full Time
Tasks
- Analyze data analysis and audit outcomes
- Assist in interviewing plan members
- Assist with provider profiling
- Communicate audit findings to stakeholders
- Conduct audits of claims
- Document investigative steps and outcomes
- Identify track and communicate fraud and abuse trends
- Prepare delist recommendations regulatory complaints and criminal briefs
- Prepare packages for onsite audits
- Recommend continuous improvement
- Recommend dental providers and clinics for investigation
- Respond to inquiries and escalations
- Review dental claims for fraud flags
- Support fraud prevention education and awareness
- Triage tips and referrals
Perks/Benefits
Skills/Tech-stack
Auditing | Claim Review | Contractual Language | Contractual Language Analysis | Data Analysis | Dental terminology | Email communication | English communication | Excel | Fraud investigation | French communication | Language analysis | Microsoft Outlook | Microsoft Word | Provider profiling | Stakeholder Communication | Tableau
Education
N/A
Roles
Regions
Countries
States
Cities
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