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Investigative Review Specialist

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Canada Life

15d ago

  • Job
    Full-time
    Junior Level
  • Legal
    Healthcare
  • Winnipeg

AI generated summary

  • You need dental industry experience, 2+ years in investigative/analytical roles, knowledge of dental practices, strong decision-making skills, and proficiency in Microsoft apps.
  • You will investigate cases, analyze data, communicate with parties, document findings, identify fraud risks, collaborate on projects, and mentor team members while staying updated on industry trends.

Requirements

  • Dental Clinic or Dental industry experience is required
  • 2+ years related work experience in an adjudicative, investigative, and/or analytical field or clinic setting
  • In-depth knowledge of dental industry practices and procedure including coding and billing processes
  • Completion of post-secondary level education (e.g. university or college degree/diploma)
  • A combination of relevant experience and education will be considered
  • Professional designation in a relevant regulated healthcare field (Dental Hygiene, Dental Assistant) would be considered an asset
  • Solution oriented with strong decision-making, problem-solving skills and analytical skills
  • Strong customer service mindset
  • Excellent communication skills, both verbal and written, in fast-paced and unscripted situations
  • Excellent organizational and time management skills; able to manage multiple, simultaneous investigations and re-prioritize as priorities change
  • Demonstrated proficiency using Microsoft applications such as Excel, Word and Outlook.
  • Ability to communicate in French is considered an asset
  • Workplace Solutions Operations knowledge (including legacy systems) would be an asset
  • Due to the high profile of a number of our clients, a Federal Government Enhanced Screening is a job requirement which will involve fingerprinting and a credit check. This is a personnel security status that is required before an employee can gain access to Protected B information, assets or work sites as outlined by the Government of Canada website. The cost of submitting these checks will be covered by Canada Life.

Responsibilities

  • What you will do:
  • Conduct thorough case investigations identified through various detection channels
  • Understand and interpret data from various sources
  • Develop and execute the investigative plan in a timely manner to obtain evidence where fraud or abuse is suspected by contacting (verbal and/or written) appropriate parties, including plan member, claimant and/or provider
  • Work closely with other members of the team including investigators, data analysts and the Special Investigations unit
  • Consult with Health and Dental subject matter experts, medical review board and/or consultants, regulatory bodies, Legal or other internal departments as warranted by the case
  • Accurately document investigative actions and outcomes according to department policy
  • Where evidence supports an action, determine and execute the appropriate action according to established protocols
  • Create comprehensive reports regarding investigative findings to support criminal, recovery, civil or labour relations actions as needed
  • Communicate case information as necessary according to established protocols
  • Identify fraud and abuse risks and make recommendations to mitigate future risk
  • Collaborate on special projects as assigned including targeted investigations, department process innovations and system enhancements
  • Participate in training and mentorship opportunities to other members of the team
  • Keep current on industry trends and maintain appropriate professional development

FAQs

What is the job title for this position?

The job title is Investigative Review Specialist – Fraud Management (DPIS), Workplace Solutions.

What type of work experience is required for this position?

The position requires 2+ years of related work experience in an adjudicative, investigative, and/or analytical field or clinic setting, with dental clinic or dental industry experience being a necessity.

Is prior dental experience necessary for this role?

Yes, dental clinic or dental industry experience is required.

What are the working hours for this position?

The working hours are flexible within core business hours of 7am-5pm CST, with the requirement to work 3 days a week in the office.

What skills are essential for the Investigative Review Specialist role?

Essential skills include superior written and verbal communication, problem-solving, organizational skills, and the ability to manage multiple investigations simultaneously.

Will there be any training provided for this role?

Yes, there will be an internal training program for the Investigative Review Specialist after hiring.

What kind of benefits does Canada Life offer?

Canada Life offers a competitive rewards program, tuition reimbursement, paid vacation, personal days, and the opportunity to participate in team-building activities.

Is knowledge of the dental billing process required for this job?

Yes, in-depth knowledge of dental industry practices, coding, and billing processes is required.

What educational qualifications are necessary for this position?

A completion of post-secondary level education (e.g., university or college degree/diploma) is required, although a combination of relevant experience and education will be considered.

Is there an opportunity for professional development in this role?

Yes, there are opportunities for professional development, including training and mentorship for other team members.

What background checks are required for this position?

A Federal Government Enhanced Screening, which includes fingerprinting and a credit check, is required before gaining access to Protected B information.

Is the ability to communicate in French considered an asset?

Yes, the ability to communicate in French is considered an asset for this position.

How can one apply for this position?

Interested applicants can apply directly to the job posting via the Canada Life careers website.

What is the salary range for this position?

The base salary range for this position is between $43,800.00 and $65,700.00 annually, excluding other variable compensation components.

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Canada Life

Helping Canadians improve their financial, physical and mental well-being.

Finance
Industry
10,001+
Employees
1847
Founded Year

Mission & Purpose

At Canada Life, we’re focused on improving the financial, physical and mental well-being of Canadians. Whether handling policy claims, help growing and protecting clients’ retirement and investment savings, providing workplace mental health support for all employers or helping build stronger communities by investing in community projects, we are committed to putting the customer first in all that we do. That trust is built on the dedication, skill and energy of our employees and advisors and their commitment to our customers and to our communities. Canada Life is a subsidiary of Great-West Lifeco Inc. and is a member of the Power Corporation group of companies.