Job Description

You are as unique as your background, experience and point of view. Here, you\xe2\x80\x99ll 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.

:

Fraud management is increasingly important to policyholders. To serve Sun Life\xe2\x80\x99s clients as industry leaders, Canadian Operations\xe2\x80\x99 Fraud Risk Management area will identify, mitigate and respond to criminal threats using various tools, technologies and strategies. This role has a requirement for strong dental knowledge paired with investigative skills. Reporting to the Director of Fraud Risk Management (FRM), the successful candidate will be an integral part of the dental investigations team. They will collaborate closely with FRM leaders, dental Investigators and Analysts, as well as other stakeholders who are responsible for fraud detection, prevention and investigation of dental claims across Canada. Using their advanced dental knowledge and investigative excellence, the successful candidate will provide their expertise to ensure claims are paid in accordance with all policy requirements and standards. Referrals to regulatory bodies or law enforcement may occur when there are findings of dishonest, fraudulent, or abusive claiming involving dental providers and clinics. The Senior Investigator will be required to present findings, file regulatory complaints, prepare police cases, and give evidence at regulatory, civil and/or judicial hearings.

What will you do

Identify high-risk areas of fraud and abuse in the dental landscape and make recommendations to address control gaps and continuous improvements including new investigative opportunities, strategies, and process improvements.

Provide expertise, strategic direction, and \xe2\x80\x9cbest practices\xe2\x80\x9d in support of claim verifications and resulting investigations

Review appeals to make decisions regarding claim cutbacks, declines and adjustments as well as provider eligibility status.

Mentor Investigators and share feedback in response to their investigative approaches including report writing, site audits, investigative strategies, etc.

Prepare for and participate in regulatory, civil and/or judicial hearings related to Sun Life investigations

Review, assess, and recommend decisions on audits, cases and claim outcomes based on patient files, investigative findings and supporting evidence.

What do you need to succeed

Minimum of two years dental industry expertise attained through experience as a dental assistant, hygienist, or other related profession.

Knowledge and understanding of the practice expectations, scope of practice and standards of practice established by the regulatory bodies of Oral Health Care providers.

Effective communicator able to convey information verbally and in writing in a clear and concise manner for the intended audience.

Knowledge of dental insurance benefits and regulatory environments. \xe2\x80\xa2

Understanding of interviewing and investigative principles and practices

Understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry.

As this position is posted in several locations, we specify that bilingualism (French, English, both oral and written) is required for Quebec only for the frequent interactions with English and French-speaking colleagues or internal partners across Canada or worldwide.

Location, Travel and Special Notes:

This position can be based in Montreal, Waterloo or Toronto with occasional travel.

The candidate retained for this role will be required to gain a special clearance from the Royal Canadian Mounted Police. To see if you are eligible for this clearance, please review section 201 on the Federal Government site

What\xe2\x80\x99s in it for you?

We\xe2\x80\x99re proud to be recognized as a company with a 2023 Most Trusted Executive team by Great Place to Work\xc2\xae Canada

Access to short-term assignments or \xe2\x80\x98Gigs\xe2\x80\x99 across the organization, to help you develop new skills and connections.

A collaborative and interactive team environment

Charitable giving through our You Give, We Give program lets you give back to your community \xe2\x80\x93 and in many cases, we\xe2\x80\x99ll match your contributions.

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 .

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: 76,000/76 000 - 125,000/125 000

Job Category: Risk Management

Posting End Date: 07/02/2024

Sun Life Financial