Investigation analyst (dental)

The Investigation Analyst, Investigation Services is responsible for applying Group Benefits and dental knowledge to identify, investigate and prevent dental fraud and abuse. Excellent customer service skills, problem-solving abilities and attention to detail are key attributes required for success in the Dental Abuse Management and Investigation Team.

Position Responsibilities

• Perform risk-based data profiling and analysis to identify trends and outliers in various categories for further review and investigation.
• Lead and support audit programs; coordinating, assessing, and making decisions on investigations.
• Take initiative and lead investigations to successful conclusions including the preparation of concern letters, criminal and regulatory complaints.
• Conduct interviews of plan members, providers of service and others.
• Create written audits and other correspondence to plan members, providers of service and others.
• Engage, interact, and consult with various internal contacts such as Customer Service, Legal, Client Relations, Medical Consultants, Regional Group Office and external stakeholders such as Health Practitioner Regulatory Bodies, Colleges and Associations and Plan Sponsors.

Required Qualifications:

• Knowledge of Group Benefits.
• Knowledge of the Canadian healthcare environment, service delivery model and regulation.
• Knowledge of dental codes and billing practices.
• University degree or equivalent work experience.
• Knowledge of fraud and abuse risk, and techniques to manage risk.
• Strong research, problem solving and decision-making skills.
• Ability to manage contentious interactions with various stakeholders.
• Excellent oral communication (both phone and face to face) and written communication skills.
• Intermediate data analysis skills with expertise using Excel and other data mining software.
• Demonstrated investigation skills with attention to detail.
• Ability to be creative, critical and aggressive in managing audit and investigative activities.
• Organizational skills and the ability to manage multiple conflicting priorities.

Preferred Qualifications:

• Dental Assisting or Dental Hygiene experience is an asset.
• Bilingualism in French is an asset.

When you join our team:

• We’ll empower you to learn and grow the career you want.
• We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.
• As part of our global team, we’ll support you in shaping the future you want to see.

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