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Bilingual Investigative Analyst – Fraud Risk Management
Sun LifeBilingual Investigative Analyst in Fraud Risk Management reviewing dental claims for fraud detection. Collaborating across teams to identify and investigate fraudulent claiming activities.
Tech Stack
Tools & technologiesTableau
About the role
Key responsibilities & impact- Conduct reviews of plan member and service provider claiming behavior to rule out fraud or abuse
- Using data analysis and audit outcomes, recommend dental providers and clinics for investigation
- Identify, track and communicate emerging fraud and abuse trends
- Triage tips and referrals related to inappropriate administration practices of dental providers
- Provide support to the Investigator on active profiling of dental providers
- Assist in interviewing plan members and prepare packages for onsite audits
- Timely collection and documentation of investigative steps and outcomes
- Action and respond to inquiries and escalations
- Confidently communicate audit findings to a variety of audiences
- Promote education and awareness related to fraud prevention
Requirements
What you’ll need- Bilingualism (French, English, both oral and written) is required
- Minimum of two years dental industry expertise
- Excellent communications skills both verbal and written
- Strong knowledge of dental benefits and dental terminology
- Ability to work independently in a fast-paced environment
- Strong decision-making skills and attention to detail
- Advanced computer skills (Word, Excel, Tableau, Outlook)
Benefits
Comp & perks- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data analysisaudit outcomesinvestigative stepsdental benefitsdental terminology
Soft Skills
bilingualismcommunication skillsdecision-making skillsattention to detailindependence