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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in risk-based data profiling and analysis, with strong investigation skills and the ability to engage effectively with diverse stakeholders. Proficient in managing audit programs and delivering presentations, while being bilingual in French and English.
Highest-signal resume keywords
Bilingual (French & English)CFE DesignationKnowledge of Group BenefitsIntermediate Data Analysis SkillsKnowledge of Canadian Healthcare Environment
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data ProfilingData AnalysisInvestigation SkillsResearch SkillsDecision-Making Skills
Soft Skills
Problem SolvingOrganizational SkillsCommunication Skills
Tools & Technologies
ExcelData Mining Software
Certifications & Qualifications
CFE Designation
Industry Keywords
Group BenefitsHealthcare RegulationFraud and Abuse RiskService Delivery Model
About the role
Key responsibilities & impact- Perform risk-based data profiling and analysis to identify trends and outliers for review and investigation
- Lead and support audit programs, including coordinating, assessing, and making decisions on investigations
- Lead investigations to successful conclusions, including preparing criminal and regulatory complaints
- Conduct interviews with plan members, providers of service, and others
- Create written audits and correspondence for plan members, providers of service, and others
- Engage and consult with internal contacts including Customer Service, Legal, Client Relations, Medical Consultants, and Regional Group Office
- Engage with external stakeholders including Health Practitioner Regulatory Bodies, Colleges, Associations, and Plan Sponsors
- Lead, support, and implement investigative projects
- Deliver presentations to new and existing clients
- Support the Manager with projects and initiatives
- Travel as required, including outside core working hours
Requirements
What you’ll need- Bilingual (French & English) is required
- University degree or equivalent work experience
- Knowledge of Group Benefits
- Knowledge of the Canadian healthcare environment, service delivery model and regulation
- CFE designation is an asset
- Knowledge of fraud and abuse risk, and techniques to manage risk
- Strong research, problem solving and decision-making skills
- Ability to manage contentious interactions with various stakeholders
- Excellent oral communication (both phone and face to face) and written communication skills
- Intermediate data analysis skills with expertise using Excel and other data mining software
- Demonstrate investigation skills with attention to detail
- Ability to be creative, critical and aggressive in managing audit and investigative activities
- Organizational skills and the ability to manage multiple conflicting priorities
- Ability to travel and work outside of core working hours
Benefits
Comp & perks- Flexible work environment
- Health insurance
- Dental insurance
- Mental health benefits
- Vision insurance
- Short- and long-term disability insurance
- Life and AD&D insurance coverage
- Adoption/surrogacy benefits
- Wellness benefits
- Employee/family assistance plans
- Retirement savings plans
- Pension
- Global share ownership plan with employer matching contributions
- Financial education and counseling resources
- Paid holidays
- Vacation
- Personal days
- Sick days
- Statutory leaves of absence
- Learning and career growth support
- Equal access to employment and reasonable accommodation support