Investigation Consultant – Provider Risk

Title of the Job: Investigation Consultant – Provider Risk

Location: Waterloo, ON

Job Description: The Risk Management Department supports key operational objectives, including Digital Claims Risk Management, Abuse Management, Fraud Investigations, Technical Support, Analytics, and Claims Experience Management. The Investigation Consultant, Provider Risk focuses on preventing, detecting, and investigating fraud and abuse by healthcare providers. Responsibilities include identifying risks, conducting investigations, supporting junior staff, and contributing to fraud prevention strategies. The role requires strong analytical, investigative, and decision-making skills, as well as knowledge of the Canadian healthcare environment and regulations. The consultant will also perform clinic audits, educate providers on fraud awareness, and liaise with internal and external stakeholders.This role, reporting to the Senior Manager, Fraud Risk Management, focuses on mitigating provider risk to protect plan sponsors and members from claims fraud. Key functions include investigating service providers, mentoring junior staff, representing the program to management, and supporting ongoing reporting and KPIs.Position Responsibilities:Audit and Investigation Management: Redesign and execute audit plans, perform on-site provider audits, develop alerts, negotiate overpayments, and pursue legal actions while collaborating with professional associations and regulatory bodies.Provider Inspections and Interviews: Conduct site inspections, review documents, and interview providers and their staff during audits or investigations, often requiring immediate decision-making and negotiation.Risk and Fraud Mitigation: Lead the development of investigative models, support fraud data analytics, assess risks, and implement strategies to protect client investments from high-risk providers and suspicious transactions.Mentoring and Knowledge Sharing: Mentor junior staff in fraud detection, develop communication materials on fraud prevention for various stakeholders and maintain up-to-date knowledge of audit and investigative techniques.Stakeholder Engagement and Representation: Participate in sensitive meetings with plan sponsors, represent Manulife in industry groups, support the Senior Manager, and be prepared for flexible travel requirements.Required Qualifications:Strong knowledge of Group Benefits and fraud/abuse risk management techniques.Knowledge of the Canadian healthcare environment, service delivery model, and regulations.University degree or equivalent work experience.Advanced data analysis skills with expertise in Excel and data mining software.Strong research, problem-solving, decision-making, and investigative skills with attention to detail.Excellent oral and written communication skills;Ability to manage contentious interactions and coach junior staff, acting as a Program Lead.Exceptional time management and organizational skills, capable of handling multiple priorities in a fast-paced environment.Preferred Qualifications:Good knowledge of compliance issues, provincial laws, and regulations governing insurance and privacy.Certified Fraud Examiner (CFE) designation is an asset.Bilingualism is an assetWhen you join our team:We’ll empower you to learn and grow the career you want.We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.As part of our global team, we’ll support you in shaping the future you want to see.#LI-HYBRIDAbout Manulife and John HancockManulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit .Manulife is an Equal Opportunity EmployerAt Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact .Primary Location Waterloo, OntarioWorking ArrangementHybridSalary range is expected to be between $56,400.00 CAD – $94,000.00 CADIf you are applying for this role outside of the primary location, please contact for the salary range for your location. The actual salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education/training. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.Manulife offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans. We also offer eligible employees various retirement savings plans (including pension and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in Canada includes holidays, vacation, personal, and sick days, and we offer the full range of statutory leaves of absence. If you are applying for this role in the U.S., please contact for more information about U.S.-specific paid time off provisions.

Company Name: Manulife

Salary:

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