Bilingual Dental Investigator

Job Description:

Fraud management is increasingly important to policyholders. To serve Sun Life’s 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 Manager 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.

Accountabilities

• 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.

Competencies

• Bilingualism (French, English, both oral and written) is required for the frequent interactions with English and French-speaking colleagues or internal partners across Canada and worldwide.
• 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).

Nice to have

• Previous dental audit / investigation / interviewing experience.
• University degree or post-secondary education is an asset.

Location, Travel and Special Notes:

• This position is hybrid and can be based in Montreal, Waterloo or Toronto with occasional travel.
• As a condition of the role, the successful candidate must obtain a Government of Canada Reliability Status security clearance through Sun Life

What's in it for you?

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

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 factors. In 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 [email protected].

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible 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.