LTC Fraud Consultant

🕒 May 22

🐊 Florida, New Hampshire, +2 more states – Remote

🐊 Florida – Remote 🗻 New Hampshire – Remote 🗽 New York – Remote 🍂 Massachusetts – Remote

💵 $73.3k - $122.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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Manulife

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1887

💸 Finance

⚕️ Healthcare Insurance

💰 $1.2G Post-IPO Debt on 2023-03

Finance • Insurance • Healthcare Insurance

Manulife is a leading international financial services group based in Canada, offering a range of insurance and wealth management products to customers across North America, Asia, and Europe. The company is dedicated to helping people with their financial and healthcare needs through innovative solutions in insurance, investment, and retirement planning. Manulife is notable for its commitment to sustainability, diversity, equity, and inclusion. It has been recognized as one of Canada’s Top 100 Employers, demonstrating its dedication to creating a supportive and diverse workplace. With operations spanning numerous countries, Manulife is committed to delivering strong financial performance and customer satisfaction.

📋 Description

• Lead targeted customer outreach to explain updated claim reimbursement controls, drive adoption, and support understanding and compliance. • Spend approximately 60% of the role on the phone conducting customer outreach related to claim reimbursement controls, education, and support. • Analyze LTC claims and provider billing patterns to identify potential fraud, waste, and abuse. • Prepare data extracts, dashboards, and concise analytic summaries to support case development and investigations. • Monitor and communicate emerging fraud schemes; help design mitigations, controls, and process improvements. • Partner cross-functionally with investigators, clinical teams, and technology teams to improve fraud operations and detection capabilities. • Gather and document business needs (requirements, user stories, process flows) for enhancements to fraud detection and case management tools. • Support performance monitoring and reporting for the LTC FWA program, and contribute to continuous improvement across fraud operations.

🎯 Requirements

• 3–5 years of experience in Long-Term Care (LTC), healthcare/insurance business analysis, and/or Fraud, Waste & Abuse (FWA) • Strong analytical and critical-thinking skills; able to interpret complex claims and operational data • Ability to translate findings into clear artifacts (business requirements, user stories, process flows) • Advanced Excel skills and comfort with large datasets; familiarity with SQL/SAS and/or BI tools (Power BI/Tableau) a plus • Clear written and verbal communicator; able to work effectively with both technical and non-technical stakeholders while managing multiple priorities • Experience with fraud investigations/SIU and familiarity with Medicaid and/or commercial LTC benefits and fraud/case management tools preferred.

🏖️ Benefits

• health, dental, mental health, vision insurance • short- and long-term disability insurance • life and AD&D insurance • adoption/surrogacy benefits • wellness benefits • employee/family assistance plans • retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions) • financial education and counseling resources • 11 paid holidays • 3 personal days • 150 hours of vacation • 40 hours of sick time