Bilingual Investigative Analyst - Fraud Risk Management
$49,000–$77,000 year
Hybrid · Toronto, Ontario, Canada or Montréal, Quebec, Canada
Job Summary
Bilingual Investigative Analyst position focusing on fraud risk management in dental benefits. Responsibilities include reviewing plan member and service provider claiming behavior to rule out fraud or abuse, using data analysis and audit outcomes to identify providers for investigation, tracking emerging fraud trends, triaging referrals related to inappropriate administration practices of dental providers, supporting Investigators with active profiling, interviewing plan members, preparing packages for onsite audits, documenting investigative steps, communicating audit findings to diverse audiences, and contributing to delist recommendations, regulatory complaints, and criminal briefs. Requires strong French-English bilingual communication, experience in the dental industry, knowledge of dental terminology and benefits, independent work capability in a fast-paced environment, and proficiency with data tools. The role supports hybrid work arrangements with Sun Life offices in Canada (Montreal, Toronto, Waterloo). The position includes a focus on fraud prevention, education and awareness, and collaboration across internal and external stakeholders.
Required Qualifications
- Minimum of two years dental industry expertise attained through experience working in a dental office
- Bilingualism (French and English) for frequent interactions across Canada and worldwide
- Excellent communications skills both verbal and written
- Strong knowledge of dental benefits and dental terminology
- Ability to work independently in a fast-paced environment and collaborate across teams
- Knowledge of contractual language, administration guidelines, and provincial/federal legislation applicable to the industry
- Strong decision-making skills and attention to detail
- Advanced computer skills (Word, Excel, Tableau, Outlook)
- Assets: Experience in audit or investigations
- University degree or postsecondary education
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