Bilingual Dental Investigator
Bilingual Dental Investigator
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Job Description
You are as unique as your background experience and point of view. Here youll be encouraged empowered and challenged to be your best self. Youll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day youll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals families and communities around the world.
Job Description:
Fraud management is increasingly important to policyholders. To serve Sun Lifes clients as industry leaders Canadian Operations Fraud Risk Management area will identify mitigate and respond to criminal threats using various tools technologies and strategies.
Reporting to the Manger for Fraud Risk Management (FRM) the Bilingual Dental Investigator will be responsible for fraud detection prevention and investigation into extended health care benefits fraud across Canada. Using data analytics advanced interviewing skills and investigative excellence the successful candidate will focus on the identification and investigation of situations involving dishonest fraudulent and abusive claiming involving dental providers clinics and plan members.
Investigations require regular contact with external stakeholders including plan members dental providers associations and colleges. The Investigator will be required to present findings file regulatory complaints prepare police cases and give evidence at regulatory civil and/or judicial hearings.
What will you do
Identify high-risk areas of fraud and abuse in the dental landscape and make recommendations to address control gaps and continuous improvement.
Investigate situations of fraud and/or abuse with a focus on dental providers clinics and plan members.
Identify trends report on issues and suggest appropriate actions to internal and external stakeholders.
Identify and partner in the development and implementation of processes for handling investigations.
Conduct plan member and provider interviews.
Perform onsite audits of service providers.
Action and respond to inquiries and escalations.
Make quick-thinking and decisive decisions when handling files.
Maintain all databases and logs pertaining to investigations.
Prepare documentation such as investigation reports management briefings or other communications in a professional confident and proficient manner.
Research gather data and present findings in a variety of settings and to a variety of internal and external stakeholders including clients service providers Legal internal business partners and senior management.
Prepare for and participate in regulatory civil and/or judicial hearings to resolve investigations.
Promote education and awareness to internal and external stakeholders related to fraud prevention.
Keep up to date on industry trends and schemes impacting benefit plans.
What do you need to succeed
Minimum of two years dental industry expertise attained through experience as a dental hygienist dental assistant dental office manager or other related profession
Strong knowledge of dental terminology and expense codes
Knowledge of dental insurance benefits and regulatory environments
Understanding of interviewing and investigative principles and practices
Strong research and analysis skills
Understanding of contractual language administration guidelines and provincial and federal legislation applicable to the industry
Strong decision-making skills and innovative thinking
Ability to effectively negotiate and influence
Adaptable to a fast-paced environment and can work well independently and collaboratively
Strong analytical skills with attention to accuracy and details
Advanced computer skills (Word Excel PowerPoint Outlook Tableau)
Fluency in English and French (spoken and written) required due to frequent interactions with internal English- and French-speaking colleagues or internal partners across Canada
Assets
Previous dental audit / investigation / interviewing experience
University degree or post-secondary education is an asset
Location Travel and Special Notes:
This position can be based in Montreal Waterloo or Toronto with occasional travel.
To see if you are eligible for this clearance please review the section 201 on the Federal Government site ( in it for you
We are proud to be on the 2024 Best Workplaces in Canada list by Great Place to Work.
Were also listed as one of the Best Workplaces for Women and Best Workplaces with Most Trusted Executive Teams.
In 2024 Sun Life ranked among the top 100 most sustainable global corporations by Corporate Knights for the 15th consecutive year leading Canadian insurers.
A caring supportive and inclusive culture
Flexible Benefits from the day you join to meet the needs of you and your family
Time off giving you the flexibility to focus on the moments that matter.
Care Days available for self-care or care of others (i.e. family or others you may support) and Sick Days to support your well-being.
*LI-MS
The Base Pay range is for the primary location for which the job is posted. It may vary depending on the work location of the successful candidate or other addition to Base Pay eligible Sun Life employees participate in various incentive plans payment under which is discretionary and subject to individual and company performance. Certain sales focused roles have sales incentive plans based on individual or group sales results.
Diversity and inclusion have always been at the core of our values at Sun Life. A diverse workforce with wide perspectives and creative ideas benefits our Clients the communities where we operate and all of us as colleagues. We welcome applications from qualified individuals from all backgrounds.
Persons with disabilities who need accommodation in the application process or those needing job postings in an alternative format may e-mail a request to .
We are proud to be a hybrid organization that offers our employees the choice and flexibility to work from both the office and virtually based on the needs of the business our Clients and you! Several work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
We thank all applicants for showing an interest in this position. Only those selected for an interview will be contacted.
Salary Range:
54000/54 000 - 91000/91 000Job Category:
Risk ManagementPosting End Date:
31/08/2025
Employment Type
Full-Time
