You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.
The Investigator will investigate situations involving possible dishonest, fraudulent, and/or abusive activities related to Group Benefits claims, with a focus on Disability files. Responsibilities include assessing identified leads, plan sponsors, service providers, and attending physicians, reporting findings to Compliance & Governance and Group Benefit Disability representatives, possibly presenting evidence to police and regulatory bodies, training and consulting, and supporting presentations regarding the Disability Claims Disability Investigation Program.
What will you do?
Conduct a formal inquiry when fraudulent Disability claims, or related dishonest activity is suspected
Conduct interviews and take statements from plan sponsors, service providers, attending physicians, and other third parties
Prepare and file regulatory complaints and police case referrals
Collaborate with Disability Claims area to recover overpayments
Assist in coordinating efforts between FRM and Disability Claims to identify and investigate claims fraud and plan abuse
Provide investigative expertise and related reporting on cases to FRM management, the Ombudsman, Disability Claims, Business Development, Customer Care Centre, and other pertinent internal and external stakeholders
Collect, safeguard investigation evidence and maintain all databases and logs pertaining to investigations
Remain current and up to date on industry trends/education/products/privacy laws/etc.
Assist in training and educating internal and external stakeholders on FRM’s Disability Claims Investigation fraud processes
What do you need to succeed?
Experience in Disability claims (short and long term disability)
Audit/investigation experience within the insurance industry
Knowledge of medical terminology
Bilingual (French and English)
Analytical and decision making skills
Experience performing interviews
Data analysis experience to drive decisions and/or actions
Knowledge of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry
Knowledge of Word, Excel, Power Point, Access
What’s in it for you?
A friendly, collaborative and inclusive culture
A collaborative and interactive team environment
Working together, sharing common values and encouraging growth & achievement
The Base Pay range is for the primary location for which the job is posted. It may vary depending on the work location of the successful candidate or other factors. In addition to Base Pay, eligible Sun Life employees participate in various incentive plans, payment under which is discretionary and subject to individual and company performance. Certain sales focused roles have sales incentive plans based on individual or group sales results.
Diversity and inclusion have always been at the core of our values at Sun Life. A diverse workforce with wide perspectives and creative ideas benefits our clients, the communities where we operate and all of us as colleagues. We welcome applications from qualified individuals from all backgrounds.
Persons with disabilities who need accommodation in the application process or those needing job postings in an alternative format may e-mail a request to firstname.lastname@example.org.
We thank all applicants for showing an interest in this position. Only those selected for an interview will be contacted.
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