Experienced Health and Dental Claim Fraud Strategy Specialist

Manion Wilkins & Associates - Toronto, ON (30+ days ago)

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Manion is an independently owned Canadian firm that provides third-party group benefits administration, payments and consulting services. We provide solutions that streamline the administration of an organization’s pension and health benefits programs to deliver the highest value to our clients. A significant part of that undertaking is the administration of Health and Dental Claims.

We are looking for a strong technologically adept special investigations and fraud leader to join our close-knit and growing team. We hope our search ends now, with you.

This role is located in our Etobicoke, ON office, with the possibility of working from home a couple of days per week, and will report to the Director, Health & Dental Benefits Support. As we look to grow the fraud prevention initiatives, this role may become a supervisory role in the future. The successful candidate will be responsible for the following:

Partner with the Director to develop a special investigations and fraud strategy as well as organizational structure with the client experience in mind.
Design and execute a plan to protect our client’s benefits investment by addressing fraud, waste and minimizing financial errors.
Develop strong business relationships with internal sales and service partners that depend on the delivery of a “best in class” claims experience.
Build a team of Health & Dental Claims Experts that participate in the identifying possible special investigation cases.


Post-secondary degree or diploma in a business-related field
4 plus years progressive experience in the group benefits industry. A focus on health & dental claims and applicable regulatory standards and best practices
Minimum 3 years of experience with claims fraud and waste management, in health & dental claims
Industry designation in employee benefits (e.g. CEBS) is an asset

A great fit for this role will have skills and experience that resonate with the following statements:

Advanced knowledge of how special investigations can work within a highly effective claims adjudication process and applications. A track record of developing technology and process to drive efficiency, accuracy and improve the client experience within the context of special investigations.
Possesses first-hand knowledge of “before the claim arrives” fraud and waste prevention strategies.
Informal leader of people and contributes a culture that positively impacts the client experience. Emulates that mindset.
Data driven decision maker. If the data doesn’t exist, knows how to create it.
Focused on achieving service and quality targets and standards.

Working @ Manion

This is a full-time permanent position. We offer competitive salary and benefits, pension and group RRSP plans, and access to Goodlife Fitness at the discounted corporate rate. Our office is also surrounded by a number of amenities, and you’ll have free parking in our underground lot.

We have a very strong family-oriented culture. Our work is meaningful, connecting people to healthier lives. The biggest reason we love coming to work is that we love working together. That’s why finding the right fit is so important to us.

This is a fun, vibrant community to work in every day. We know each other by name, our social and wellness committees help us celebrate achievements, mark life events, and facilitate activities on a regular basis.

We value diversity and inclusion and encourage all qualified people to apply. If we can make this easier through accommodation in the recruitment process, please let us know.

Want to be part of a rapidly growing company that is transforming the way Canadian’s experience benefits? Apply now!

We thank everyone who applies to the Fraud Strategy Specialist role; due to the volume of applications we receive, we are only able to contact candidates who have been selected for an interview.

Fraud; Loss Prevention; Customer-Service; third-party benefits; full-time; Full-Time; Health and Dental Claims; Special Investigations