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Job Description:

Role Summary:

Fraud risk management is increasingly important to Plan Sponsors.  As an integral member of the management team, in this role as Team Leader, Fraud Risk Management Unit (FRM) you’re accountable for leadership of a team of investigative analysts who conduct initial risk assessments and administrative tasks.  You’ll work in close partnership with other FRM leaders to ensure the successful delivery of all business objectives.  The incumbent will play a key role in contributing to the setting and prioritizing of operational and change initiatives to leverage existing processes, technologies and our people to meet current and future business needs.  The incumbent will also be accountable to develop business partnerships with areas that support the team and service delivery such as Customer Care Centre, Group Health & Dental (H & D) Claims, Business Analytics, and the Fraud Intelligence Analysts.

With the need to continuously adapt and evolve the incumbent will be responsible for leading changes while maintaining day to day delivery of service. 

Main Accountabilities:

• Provide leadership to ensure the daily effective delivery of a consistent service experience
• Accountable for the management of a high-volume, production-oriented team
• Working in collaboration with the Sr. Best Practices Consultant, maintain policies, standards, and operating procedures
• Participate in setting and delivering on the Business Unit’s strategies, goals and initiatives to contribute towards a fully integrated Health & Dental Claims Operation of which the Fraud Risk management Unit is a critical part
• Support and champion the overall continuous improvement and innovation agenda for FRM ensuring that all change is sustainable and consistently exceeds the expectations of Sun Life’s Plan Members, Plan Sponsors, and distribution partners
• Collaborate effectively with colleagues cross-functional projects and initiatives, providing input as required
• Lead and support direct reports in executing quality service delivery and support them by providing direction, setting clear expectations, performance metrics and feedback, recognition, and holding individuals accountable for results. 
• Develop the team’s competencies to fully utilize individual team members strengths and talents
• Monitor emerging trends in health care to identify potential risk of misuse or abuse of health and dental claims
• Manage small continuous improvement projects through entire cycle from inception to post-implementation monitoring

Competencies:

• Minimum of 3-5 years experience working in a high-volume, production-oriented environment, managing a team focused on Fraud and Abuse Management, particularly as it relates to Dental claims is required
• Proven track record leading a team, with demonstrated ability to create win/win solutions with business partners and facilitate cross-departmental teamwork that meets the needs of the business strategy
• Strong analytical skills
• Previous exposure or involvement in industry forums as it relates to Dental fraud an asset
• Strong communication skills (written and verbal)
• Exceptional customer focus skills
• Ability to see the impact of decisions and actions on both Plan Sponsors and Plan Members
• Ability to create change by challenging the status quo
• Ability to develop plans and implement changes
• Ability to hold others accountable
• As this position is posted in several locations, we specify that bilingualism (French, English, both oral and written) is required for Quebec only for the frequent interactions with English and French-speaking colleagues or internal partners across Canada or worldwide.

The Base Pay range is for the primary location for which the job is posted.  It may vary depending on the work location of the successful candidate or other factors.  In addition to Base Pay, eligible Sun Life employees participate in various incentive plans, payment under which is discretionary and subject to individual and company performance.  Certain sales focused roles have sales incentive plans based on individual or group sales results. 

Diversity and inclusion have always been at the core of our values at Sun Life. A diverse workforce with wide perspectives and creative ideas benefits our clients, the communities where we operate and all of us as colleagues. We welcome applications from qualified individuals from all backgrounds.

Persons with disabilities who need accommodation in the application process or those needing job postings in an alternative format may e-mail a request to [email protected].

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

We thank all applicants for showing an interest in this position. Only those selected for an interview will be contacted.

Salary Range:

56,000/56 000 - 93,000/93 000

Job Category:

Risk Management

Posting End Date:

28/11/2024