Manager, Fraud Risk Management

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 team will identify mitigate and respond to fraud threats using various tools technologies and strategies. Reporting to the Waterloo Director of Fraud Risk Management (FRM) the successful candidate will be accountable for leading a team of investigative analysts and investigators who execute a strategic proactive fraud prevention program. This proactive approach complements traditional reactive investigations by identifying and assessing risk early rather than responding to it after significant losses have accumulated.

The Manager will lead a team leveraging advanced analytics and data-driven intelligence to detect potential group health benefits fraud schemes. As the sophistication and scope of fraud schemes continue to evolve the Manager will need to lead change while maintaining daily operations.

What will you do

• Provide leadership to a team of investigative analysts and investigators focused on proactive due diligence and early detection of collusion-based fraud schemes

• Drive the strategic use of advanced analytics to identify high-risk providers and suspicious patterns before significant losses occur

• Oversee the preparation of delists regulatory complaints and police referrals

• Measure and report on the effectiveness of proactive fraud prevention initiatives demonstrating return on investment and loss avoidance

• Develop the teams competencies in advanced analytics investigative techniques and emerging fraud detection methodologies to fully utilize individual team members strengths and talents

• Lead and support direct reports in executing quality service delivery providing direction setting clear expectations coaching being available providing recognition and holding individuals accountable for results

• Conduct regular assessments on the quality of documentation risk-based prioritization of investigations and decisions made on cases

• Champion a culture of continuous improvement and innovation to deliver on the ever-evolving expectations of our plan members and plan sponsors on fraud and abuse matters

• Participate in projects involving new technologies processes and practices

• Monitor emerging trends in health care to identify potential risk of misuse or abuse of health and dental claims.

What do you need to succeed

• As this position is posted in several locations we specify that bilingualism (French English both oral and written) is required for Quebec only as the position includes managing both French and English-speaking staff (Quebec and outside Quebec) and providing daily support to the team.

• Experience leading a team focused on fraud and abuse management criminal investigations or equivalent

• Proficiency in data analytics and data interpretation for fraud detection purposes

• Strong analytical skills and critical thinking with attention to accuracy and details

• Knowledge of group insurance business (products services distribution organization systems processes) and regulatory environments

• Understanding of extended health benefits billing practices and health related fraud schemes

• Strong leadership skills ability to influence solutions and facilitate cross-departmental teamwork that meets the needs of the business strategy

• Excellent communication skills (written and verbal) and experience presenting sensitive matters to customers or senior management including the ability to explain complex findings to non-technical audiences

• Proven presentation skills

• Solid decision-making skills by understanding and assessing business needs and risks

• Superior organizational skills and ability to multi-task prioritize initiatives and execute effectively

• Experience with case management systems and fraud detection software

• Advanced computer skills (Excel Tableau or similar analytical tools)

Assets:

• University degree or postsecondary education

• Experience implementing or managing proactive fraud prevention programs

• Certifications such as CFE (Certified Fraud Examiner) CFCI (Certified Financial Crimes Investigator) or similar credentials

• Fluency in two or more languages

Unique requirement:

• Must be able to obtain RCMP Reliability Security Clearance before a start date can be confirmed (includes fingerprinting).

• This role can be based out of Waterloo Toronto or Montreal

• Some travel may be required.

Reasons why you should join us under the sun:

• The opportunity to move along a variety of career paths with amazing networking potential

• Flexible Benefits from the day you join to meet the needs of you and your family

• A caring supportive and inclusive culture

• We are proud to be on the 2024 Best Workplaces in Canada list by Great Place to Work.

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 may use artificial intelligence to support candidate sourcing screening interview scheduling.

We thank all applicants for showing an interest in this position. Only those selected for an interview will be contacted.

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