ICU Investigative Analyst

The Opportunity: At Equitable we believe great things happen when we work together. Were a Canadian mutual company driven by purpose - putting people first and helping Canadians protect today and prepare for tomorrow. If youre passionate about making a difference and growing your career in an inclusive and collaborative environment wed love to hear from you. Our culture is built on care passion and curiosity. We put people above all else strive to be our best and welcome new ideas to deliver positive this role you will play a key part in identifying assessing and preventing potential fraud and benefits abuse within Group Benefits claims. You will support the Investigative Claims Unit (ICU) through data analysis case management and investigative support that helps protect the organization from financial regulatory and reputational risk. This position offers the chance to apply strong analytical skills collaborate with crossfunctional partners and contribute to fraudprevention initiatives that strengthen overall plan one of the regions top employers and be part of something that truly makes a Arrangements: This is a hybrid role. You will work in our office in Waterloo ON a minimum of two (2) assigned consecutive days every other week plus a fifth (5th) assigned day per month. You are welcome to work from the office more than the minimum requirement and there may be some roles that are required to work in our office more than the minimum youll do:Managing the ICU Inbox Verifications Inbox OnBase queues and voicemail for incoming tips referrals and investigative and evaluating potential fraud or abuse trends using data analytics tools and external reporting initial case analysis to quantify exposure identify anomalies and highlight patterns requiring deeper up new cases maintaining accurate documentation in OnBase updating case files processing currentcase claims tracking claim savings and managing opensource searches corporate lookups and gathering relevant data for case preparation and with basic investigations and recommending cases for review or escalation to junior or senior delist summaries for director approval and managing provider delisting activities (letters system updates member notifications).Completing monthly reporting and maintaining internal resources such as wiki compliance with regulatory and internal requirements including AML obligations investigative protocols and provincial legislation related to billing to inquiries from internal partners and external stakeholders regarding case status findings or investigative group benefit projects as a subject matter expert (SME) including system enhancements and product the organization in collaborative cases with other carriers (e.g. JPFI) ensuring professionalism and alignment with investigative fraudawareness initiatives and contributing to continuous improvement within the operational risks by following established processes and flagging potential gaps or youll bring:Strong critical thinking and problemsolving skills to evaluate information identify inconsistencies and draw sound investigative in compiling analyzing and interpreting detailed data to identify unusual patterns or potential fraud using data analysis tools such as SQL Power Query Power BI or similar knowledge of health and dental claims provider billing practices medical terminology and group insurance of fraud and abuserisk management techniques with the ability to learn and apply regulatory and professional computer skills including Microsoft Word Excel and Power listening verbal and written communication skills with the ability to clearly summarize evidence and interpersonal conflictmanagement and negotiation skills to manage relationships with internal teams and external to work independently and collaboratively as an active team member within the organizational skills with the ability to manage fluctuating workloads and meet level of integrity confidentiality and commitment to data and resilience when handling sensitive highimpact prioritization skills to manage multiple complex investigations to continuous improvement and supporting departmental best in it for you:Career Growth: Regular learning sessions and developmentopportunitiesTotal Rewards: Incentive pay annual salary reviews employer-paid benefits and pensionmatchingTime Away: Competitive vacation plus one paid volunteer day each yearFlexibility: Healthy work-life balance with employee wellness always top of mind complemented by a dress for your day approachAt Equitable were committed to fair pay and an inclusive accessible hiring experience. If you need accommodations or alternative formats at any stage just reach out to us at Were happy to base pay will be based on your skills qualifications experience and addition to your salary this role is eligible for a discretionary annual incentive award tied to business performance plus a wide range of competitive benefits. If youre selected to move forward our Talent Acquisition team will walk you through all the details of our total rewards program so you know exactly whats To: Manager Group Dental Claims and Investigative Claims UnitDepartment: Group Claims Term: Permanent Full-Time