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We are looking for an Investigator - Detection, Prevention & Integrity Services, Workplace Solutions (DPIS).

The Investigator is a key member of the health and dental team that delivers robust and effective health and dental claims fraud prevention to Canada Life customers. The main function of the Investigator 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 Investigator will propose and execute recommendations regarding resolution, collaboration with special investigations, or recovery. The Investigator is responsible for ensuring that case documentation is accurate and complete and will write case reports as needed for senior leadership and clients.

As an investigator, you must possess superior written and verbal communication, problem solving, and organization skills to ensure the accurate documentation of the investigation.

• 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.

• 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; Experience in a Dental Clinic, Paramedical Clinic or Pharmacy would be an asset.
• 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.
• Demonstrated proficiency using Excel, Word and Access.
• Reliability Status Security Clearance - this can only be completed with candidates who receive an offer of employment. This is a personal security status that is required as a condition of employment 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. 
• Bilingualism (fluent in French and English) required, as the position will regularly serve our clients with English and French-speaking needs.