LTC Fraud Consultant

Job not on LinkedIn

🔥 17 hours ago

🌐 Canada, United States – Remote

🇨🇦 Canada – Remote 🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Manulife

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1887

🏥 Healthcare

💸 Finance

🛡️ Insurance

💰 $1.2G Post-IPO Debt on 2023-03

Healthcare • Finance • 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 explaining updated claim reimbursement controls • Drive adoption, understanding, and compliance with reimbursement controls • Analyze LTC claims and provider billing patterns to identify potential fraud, waste, and abuse • Prepare data extracts, dashboards, and concise analytic summaries for case development and investigations • Monitor and communicate emerging fraud schemes • Help design mitigations, controls, and process improvements • Partner with investigators, clinical teams, and technology teams to improve fraud operations and detection capabilities • Gather and document business needs, requirements, user stories, and process flows for fraud detection and case management tool enhancements • Support performance monitoring and reporting for the LTC FWA program • 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 • Ability to interpret complex claims and operational data • Ability to translate findings into business requirements, user stories, and process flows • Advanced Excel skills and comfort with large datasets • Clear written and verbal communication skills • Ability to work with technical and non-technical stakeholders while managing multiple priorities • Experience with fraud investigations/SIU preferred • Familiarity with Medicaid and/or commercial LTC benefits and fraud/case management tools preferred • Familiarity with SQL/SAS and/or BI tools such as Power BI/Tableau is a plus

🏖️ Benefits

• Flexible work environment • Health insurance • Dental insurance • Mental health benefits • 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 • Pension • Global share ownership plan with employer matching contributions • Financial education and counseling resources • Paid holidays, vacation, personal, and sick days in Canada • Statutory leaves of absence • Incentive programs and incentive compensation tied to business and individual performance