Bilingual Investigative Analyst – Fraud Risk Management

Responsibilities

• Conduct reviews of plan member and service provider claiming behavior to rule out fraud or abuse
• Using data analysis and audit outcomes, recommend dental providers and clinics for investigation
• Identify, track and communicate emerging fraud and abuse trends
• Triage tips and referrals related to inappropriate administration practices of dental providers
• Provide support to the Investigator on active profiling of dental providers
• Assist in interviewing plan members and prepare packages for onsite audits
• Timely collection and documentation of investigative steps and outcomes
• Action and respond to inquiries and escalations
• Confidently communicate audit findings to a variety of audiences
• Promote education and awareness related to fraud prevention

Requirements

• Bilingualism (French, English, both oral and written) is required
• Minimum of two y...