Investigative Review Specialist
London Life Insurance Company
CA-MB-Winnipeg
8d ago

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Investigative Review Specialist

Investigative Review Specialist

All times are in Eastern Daylight Time. Job ID 2018-15538 Company Great West Life Job Location CA-MB-Winnipeg Job Category Administrative Job Type

Job Industry

Financial Services and Banking, Insurance

Career Level

Experienced Years of Experience ..

5 / 29 / 2018

More information about this job

Job Description

The Investigative Review Specialist (IRS) is a key member of the health and dental team that delivers robust and effective health and dental claims fraud prevention to Great-

West Life customers. The main function of the Investigative Review Specialist is to conduct investigations by assessing case information and analytical aspects of the data and then contact providers and clinics to validate services to ensure that claims are free from suspicion of fraud / abuse.

The IRS works closely with their leader in determining investigative next steps as well as other members of the teams including data analysts and members of Special Investigations.

Taking into consideration the evidence and other information gathered the IRS will propose and execute recommendations regarding resolution, referral to Special Investigations or recovery.

The IRS is responsible for ensuring that case documentation is accurate and complete and will write case reports as needed for Special Investigations, senior leadership and clients.

Accountabilities :

  • Conduct thorough investigations of assigned cases as identified through various detection sources.
  • The ability to understand and interpret data from various detection sources by working closely with Analysts when required.
  • Develop and execute the investigative plan to obtain evidence where fraud is suspected by contacting (verbal and / or written) appropriate parties, including plan member, claimant and / or provider.
  • Document investigative actions and outcomes according to department policy.
  • Where evidence supports an action, determine and execute the appropriate action according to established protocols.
  • Write client-facing reports regarding investigative findings and comprehensive reports when cases are referred to Special Investigations.
  • Communicate case information as necessary according to established protocols.
  • Identify fraud and abuse risks and make recommendations to mitigate future risk.
  • Maintain accurate methods of record keeping and statistics according to department policy.
  • Work on special projects as assigned.
  • Maintain appropriate professional development.
  • Living the values of Customer View; Integrity; Partnership; and Communities.
  • Qualifications and Competencies :

  • Completion of post-secondary level education (eg : university or college degree / diploma).
  • Minimum two years related work experience in an adjudicative, investigative, and / or analytical field.
  • CFE designation would be considered an asset.
  • A combination of relevant experience and education will be considered.
  • Strong decision making, problem solving skills and analytical skills.
  • Proven experience providing excellent customer service.
  • Excellent ability to communicate, both orally and in writing, in fast-paced and unscripted situations.
  • Excellent organizational and time management skills; able to handle multiple, simultaneous investigations.
  • Strong report writing skills.
  • Strong customer service orientation.
  • Claims knowledge would be considered an asset.
  • Understanding of Group Operations (including legacy systems) / Business knowledge would be an asset.
  • Preference will be given to candidates bilingual in both official languages (French and English).
  • Demonstrated proficiency using Excel, Word and Access.
  • Discover your opportunity . Apply today!

    Great-West Life offers competitive compensation, great benefits such as medical, dental, life insurance, wellness account and personal days not to mention onsite cafeteria and fitness facilities.

    If you’d like to join our team submit your information online and introduce yourself.

    Together Great-West Life, London Life and Canada Life serve the financial security needs of more than 13 million people across Canada, with additional operations in Europe and the United States.

    As members of the Power Financial Corporation group of companies, we’re one of Canada’s leading insurers with interests in life insurance, health insurance, investment and retirement savings.

    We offer a broad portfolio of financial and benefit plan solutions for individuals, families, businesses and organizations.

    We are committed to providing an inclusive, accessible environment, where all employees and customers feel valued, respected and supported.

    We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employee has the opportunity to reach their potential.

    Great-West Lifeco would like to thank all applicants, however only those who qualify for an interview will be contacted.

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