Cowan Insurance Group
Ottawa, Ontario, Canada
3d ago

Job Summary :

The Prevention and Detection Unit (PDU) will provide support to our carrier partners as an extension of their advanced fraud investigation processes as well as identifying and confirming questionable claims for our direct clients where the responsibility of validating the expenses, transactions or players lies directly with Cowan.

The PDU will conduct reviews, audits and investigations with the utmost integrity and will ensure fact-based evidence methodology to support all investigations.

Detection processes will be based on appropriate investigative criteria designed to identify suspect behaviours and submission patterns that warrant intensive review or which are appropriate for reporting and handing off to the Carrier to be managed within their own investigative framework.

Specifically, the Examiner will :

  • be dedicated to amassing necessary supporting evidence to the point of ownership for every investigation;
  • determine when the necessary evidence has been gathered to support early notification to a Carrier of a possible fraud circumstance or carrying an investigation to its conclusion for reporting to a Client;
  • ensure that we have met the standards of due diligence on all cases; and
  • partner with Carriers on ongoing investigations to support the Carrier's investigation;
  • prepare reports and / or synopses on every case;
  • document and file every step in a case and all evidence chronologically;
  • make recommendations for process improvement opportunities at Cowan where necessary.
  • Qualifications :

  • Post-secondary education and relevant experience in the group insurance field are required;
  • Legal knowledge and familiarity with legislation related to group benefits or fraud are assets;
  • Extensive experience with claims adjudication and audit processes;
  • In-depth understanding and knowledge of plan design and policy provisions;
  • Excellent oral and written skills are mandatory; bilingualism is an asset;
  • Advanced skills in computer applications : word processing (Word), spreadsheet (Excel), presentations (PowerPoint) and personal time organization;
  • Critical thinking and problem solving skills as well as attention to detail are paramount; and
  • Strong research skills are necessary.
  • We invite interested candidates submit their resume in confidence to human.resources cowangroup.ca. While we appreciate the interest of all applicants, we will contact only those selected for interviews.

    If you are an applicant with disabilities and require accommodations, please let us know at the time of our contact so that we may arrange for their provision.

    We are an Equal Opportunity Employer. Employee candidates will be selected strictly on the basis of an individual's technical qualifications, knowledge and experience, as they relate to the requirements of a particular position.

    Selections will be made without regard to : race, ancestry, place of origin, colour, ethnic origin, citizenship, creed (religion), sex, sexual orientation, handicaps (physical or mental), age, marital status, family status, or the receipt of public assistance or record of offences.

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