WHO WE ARE When it comes to health, we''re always looking for ways to push for better. It''s why we were founded in the first place. In 1957, our founder, pharmacist William Wilkinson, witnessed a mother sacrifice her health by forgoing her own medicine to pay for her sick daughter''s prescription. He knew there had to be a better way. So, he introduced North America''s first prepaid drug plan, and GreenShield was born as a not-for-profit with a mission to support better health for all Canadians. We aren''t just a health and benefits company. We''re the only not-for-profit social enterprise that brings worlds of coverage and care together, all in one place. We''re noble challengers, purposefully building a better way and we need the best people to help us create a more holistic approach that takes care of the mind and body. Our mission is to create better health for all Canadians, and we know that starts with our employees. THE ROLE IN A NUTSHELL This role reports to the Supervisor, Claim Watch. Identify, research, and analyze areas of abuse, misuse and fraudulent claims activity from Providers and Plan Members. Conduct interviews and act as an undercover agent (mystery shopper). Communicating regularly with both internal and external stakeholders. Research trends in benefit utilization. Develop profiling criteria. Identify and make recommendations on -fraud mitigation opportunities. Work directly with stakeholders, various medical providers and governing bodies, law enforcement, etc. Build summary reports of findings and present conclusions and recommendations as required. WHO WE ARE LOOKING FOR Minimum of 3 years'' experience in audit and fraud detection, health care benefit administration, healthcare field and/or conducting investigations. A university degree or diploma in a related discipline or equivalent work experience. Established analytical, complex problem solving, and decision-making skills. Expertise in online fraud analysis. Ability to identify fraud indicators in electronic and online benefit claims, including suspicious behaviors related to the use of digital platforms. Experience in detecting fraudulent online activities, including the collection and analysis of digital evidence and the investigation of electronic fraud incidents. Working knowledge of relevant federal and provincial legislation, regulations and the judiciary system (Including but not limited to: PIPEDA, Regulated Health Professions Act, Privacy Act) would be an asset. Strong computer skills, with an ability to develop and craft reports including validation of these reports. Extraordinary consultation and negotiation skills. Strong interpersonal skills and the ability to communicate to all levels of internal and external customers both oral and written. Able to work in an independent work environment as well as in a team. Strong attention to detail, time management and organizational skills with tight deadlines and changing priorities. NICE TO HAVE Bilingual (English and French). Private Investigator license, issued by the appropriate body. A Certified Fraud Examiner (CFE) certificate. A Certified Anti-Money Laundering Specialist (CAMS) certificate GS supports diversity, equity and inclusion in our teams and communities, and we value the unique contributions made by all. Even if your experience doesn''t align perfectly to every requirement, we invite you to apply. We encourage applications from all candidates and will accommodate needs under human rights legislation throughout all stages of the recruitment and selection process. Please let us know of any accommodation through Information received relating to accommodation will be addressed confidentially. Providing this information gives GS consent to use your personal information to assess your suitability for specific positions, future opportunities or for your personnel file. Your rsum will be held in strict confidence and will be viewed only by the Organization. Information may be stored outside of Canada and could be used for aggregate statistical purposes (which uses no personal identification). AI Usage - GreenShield leverages AI to help produce Job Descriptions, and ideate on interview questions. We also leverage AI for interview transcription support.
Job Title
Investigative Analyst