Bilingual E-commerce control auditor

Overview

The Bilingual E-commerce control auditor is responsible for supporting health and dental claims fraud risk controls by authenticating claim submissions, identifying and investigating issues for action and resolution, and escalating key control issues to the claims risk management team. The auditor conducts health and dental claims audits through reviewing receipt evidence and supporting documentation, contacting providers and/or plan members to validate submissions, verifying provider licensing through internet searches and contact with professional associations and colleges, and following through on actions from these reviews for successful outcomes. The auditor will work with internal departments, including Technical Services, Customer Service, Investigation Services and H&D Operations for resolution on claims submission issues. The auditor reports to the Program Manager, Investigation Services, and helps to protect plan sponsors and members from the negative impacts of claims fraud. This role is focused on risk detection, which is the foundation for our investigation programs and a vital part of claims risk management. Position Responsibilities

Reviews audit evidence submissions by plan members to authenticate information, identifies areas of concern, actions issues for resolution, and obtains/requests additional evidence required on suspect claim submissions. Validates irregular Internet transaction activity through phone call interviews with providers and/or plan members and secures evidence on discrepancies as part of information gathering on suspect claim submission activity. Requests supporting documentation from plan members and authenticating information, identifying issues and gaps for further review and resolution. Identifies fraudulent claims, documents and gathers evidence, and supports ongoing management of investigation activity Confirms provider’s licensing credentials and legitimate business establishments through Internet searches and by contact with professional associations and colleges. Actions and resolves issues for successful audit outcomes and escalates key provider control issues to the e-commerce control management team Analyzes data to identify anomalies, trends and patterns; and supports testing, and documentation of new risk controls for continuous review of all Internet submission activity Supports awareness on e-commerce control and operational workflow issues by providing direction and information to internal Group Benefit departments such as Call Center and various Health and Dental Operation departments Required Qualifications

Bilingual (French & English) is required

- The successful candidate will be required to communicate in English and French in order to support clients from various jurisdictions outside of Quebec. Knowledge of privacy, civil and criminal legal risks, and processes Preferred Qualifications

Ability to manage contentious interactions with various stakeholders and take control of stressful situations with tact and diplomacy Excellent oral communication skills and ability to interview service providers, plan members and others for successful audit outcomes Excellent written communication skills Resourceful with a proven analytical, problem solving, and troubleshooting background Proficient in research and quick decision making Strong organizational skills and the ability to manage multiple conflicting priorities in a fast-paced changing environment as well as adapting to changes are essential Ability to take-action on ideas, situations, or opportunities before being asked Ability to be skeptical, probing, creative and aggressive in conducting authentication and investigation activity 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. About Manulife

關於宏利和恒康 宏利金融公司是一家業界領先的國際金融服務商，致力於幫助人們實現「輕鬆投資理財，樂享豐盛人生」。若要進一步了解我們，請瀏覽 https://www.manulifeim.com/institutional/tw/en 宏利是平等機會僱主 在宏利／恒康，我們擁抱多元。我們致力於吸引、培養及挽留和所服務客戶同樣多元的員工，並從而營造包容的工作環境，接納文化和個體差異。我們矢志維持公平的招聘、挽留、晉升及薪酬制度，我們管理的所有實踐及項目不會因種族、血統、原籍地、膚色、族裔、國籍、宗教或宗教信仰、信仰、性別（包括懷孕及其相關情況）、性取向、遺傳特徵、退伍軍人身份、性別認同、性別表達、年齡、婚姻狀況、家庭狀況、殘疾或受適用法律保護的任何其他因素而區別對待。 我們的首要任務是消除障礙，為員工提供平等就業機會。人力資源部代表將盡力為應徵過程中提出要求的申請人提供合理協助。申請人要求提供協助所分享的信息將會按照適用法律及宏利／恒康政策儲存及使用。應徵過程中如需協助，請聯絡 recruitment@manulife.com。 Salary location: Montreal, Quebec

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