Job Description

You are as unique as your background, experience and point of view. Here, youll 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.:Responsible for the investigation of any situation involving possible dishonest or fraudulent activities in matters pertaining to Providers, Plan Members or Plan Sponsors. Investigations can involve drug, health and dental claiming. Tasks may include identifying fraud and abuse, profiling abusers, assisting with filing complaints and or criminal cases, recovering money, suggesting contractual and administrative updates, be a business expert in health and dental benefits, assist with training and education around fraud and abuse.What will you do?Action and investigate new leads received through our various fraud prevention programs, Operations and the Call CentreConduct phone or in-person interviews with Plan Members, Patients and or Providers/FacilitiesMaintain all databases and logs pertaining to alerts and investigationsPrepare/Contribute to reports for trend analysisInvestigate/Report any situations involving possible fraudulent or dishonest activitiesProvide assistance to resolve allegations of fraudSafeguard all information collectedMake recommendations for process or system improvementsAssist in the detection and prevention of Fraud/AbuseTrain our business partners on ways to prevent fraud and abuseKeep up to date on industry changes, trends, education, products and privacy lawsWhat do you need to succeed?Strong Knowledge of Drug, Health & Dental BenefitsExceptional communication skills both verbal and writtenKnowledge of medical terminologyAble to work in an independent, fast paced work environmentPrevious audit / Investigation experience within Health and Dental Benefits is an assetStrong ability to recognize and report fraudulent / abusive behaviour and claimingKnowledge and Understanding of contractual language, administration guidelines and provincial and federal legislation applicable to the industry.Exceptional decision-making skillsExcellent PC skills ( Word, Excel, Power Point, Access)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 worldwidePreferred skillsPrevious health or dental office experience i.e dental receptionist, medical office reception/manager, Pharmacy assistant or tech etc.Previous audit / investigation experience with a focus on Medical and Dental servicesWhat's in it for you?The opportunity to move along a variety of career paths with amazing networking potentialFlexible Benefits from the day you join to meet the needs of you and your familyWere committed to creating an inclusive and respectful environment. Our goal is to make sure all our employees have the chance to live up to their full potentialWere honoured to be recognized as a 2023 Best Workplaces in Ontario by Great Place to Workxc2xae CanadaWe are thrilled to be recognized by Excellence Canada with their top-level certification, the Canada Order of Excellence for Mental Health at Workxc2xae, for prioritizing employee well-being, fostering a positive work culture, and achieving excellence in mental health*LI-MSThe 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 .At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.We thank all applicants for showing an interest in this position. Only those selected for an interview will be contacted.Salary Range: 47,000/47 000 - 77,000/77 000Job Category: Risk ManagementPosting End Date: 19/04/2025

Sun Life Financial