LTC Fraud Consultant

Manulife

LTC Fraud Consultant analyzing claims and enhancing fraud detection at Manulife. Responsible for customer outreach and fraud trend monitoring across the organization.

Posted 5/22/2026full-timeRemote • Florida, Massachusetts, New Hampshire, New York • 🇺🇸 United StatesMid-LevelSenior💰 $73,350 - $122,250 per yearWebsite

Tech Stack

Tools & technologies

SQLTableau

About the role

Key responsibilities & impact

Lead targeted customer outreach to explain updated claim reimbursement controls, drive adoption, and support understanding and compliance.
Spend approximately 60% of the role on the phone conducting customer outreach related to claim reimbursement controls, education, and support.
Analyze LTC claims and provider billing patterns to identify potential fraud, waste, and abuse.
Prepare data extracts, dashboards, and concise analytic summaries to support case development and investigations.
Monitor and communicate emerging fraud schemes; help design mitigations, controls, and process improvements.
Partner cross-functionally with investigators, clinical teams, and technology teams to improve fraud operations and detection capabilities.
Gather and document business needs (requirements, user stories, process flows) for enhancements to fraud detection and case management tools.
Support performance monitoring and reporting for the LTC FWA program, and contribute to continuous improvement across fraud operations.

Requirements

What you’ll need

3–5 years of experience in Long-Term Care (LTC), healthcare/insurance business analysis, and/or Fraud, Waste & Abuse (FWA)
Strong analytical and critical-thinking skills; able to interpret complex claims and operational data
Ability to translate findings into clear artifacts (business requirements, user stories, process flows)
Advanced Excel skills and comfort with large datasets; familiarity with SQL/SAS and/or BI tools (Power BI/Tableau) a plus
Clear written and verbal communicator; able to work effectively with both technical and non-technical stakeholders while managing multiple priorities
Experience with fraud investigations/SIU and familiarity with Medicaid and/or commercial LTC benefits and fraud/case management tools preferred.

Benefits

Comp & perks

health, dental, mental health, vision insurance
short- and long-term disability insurance
life and AD&D insurance
adoption/surrogacy benefits
wellness benefits
employee/family assistance plans
retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions)
financial education and counseling resources
11 paid holidays
3 personal days
150 hours of vacation
40 hours of sick time

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

data analysisfraud detectionbusiness analysisclaim reimbursement controlsprocess improvementrequirements gatheringuser storiesprocess flowsExcelSQL

Soft Skills

analytical skillscritical thinkingcommunicationcollaborationtime management