Investigator, 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 policy order to serve Sun Lifes clients as industry leaders Canadian Operations Fraud Risk Management area will identify mitigate and respond to fraud threats using various tools technologies and strategies.

Reporting to the Manager for Fraud Risk Management (FRM) the Investigator will be responsible for fraud detection prevention and investigation into extended health care benefits fraud schemes across Canada.

Using data analytics advanced interviewing skills and investigative excellence the successful candidate will largely focus on schemes involving medical providers and facilities.

Main Accountabilities:

• Investigate situations of fraud and/or abuse with a focus on medical providers and facilities

• Conduct plan member and service provider interviews

• Respond to inquiries and escalations

• Maintain all databases and logs pertaining to Investigations

• Prepare and participate in court/complaint cases to resolve investigations

• Research gather data prepare and organize documentation for plan sponsors police and management

• Prepare documentation such as investigation reports management briefings or other communications in a professional and proficient manner

• Identify trends report on issues and suggest appropriate actions to both internal and external clients

• Perform on-site audits of service providers

• Identify and partner in the development and implementation processes for handling investigations

• Make recommendations for continuous improvement

• Keep up to date on industry trends and schemes impacting benefit plans

Competencies:

• Previous audit / investigation / banking and interviewing experience

• Knowledge of group insurance business and regulatory environment

• Understanding of contractual language administration guidelines and provincial and federal legislation applicable to the industry

• Knowledge of medical terminology

• Superior organizational skills with the ability to develop effective investigative plans

• Exceptional communications skills both verbal and written

• Strong negotiating and influencing skills

• Needs to be able to collaborate well within a team setting

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

• Solid decision making skills and innovative thinking

• Advanced computer skills (Word Excel Lotus Notes Adobe Outlook PowerPoint Tableau)

• Identify processes to mitigate fraud abuse across benefit plans

• University degree or postsecondary education is an asset

• 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 reports to a unilingual English-speaking manager outside Quebec.

Whats in it for you

• Were proud to be recognized as a company with a 2026 Most Trusted Executive team by Great Place to Work Canada

• Access to short-term assignments or Gigs across the organization to help you develop new skills and connections.

• A collaborative and interactive team environment

• Charitable giving through our You Give We Give program lets you give back to your community and in many cases well match your contributions.

• 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.

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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