Closed listing
Claims Fraud Analyst (Insurance Claims)- EN
- Sherbrooke, QC, Canada
Windsor, Ontario Candidates: hourly salary scale ($30.00 - $35.00). *Other locations, salary to be discussed based on geographic differential. · Full-time
This opening has closed.
The original listing is kept below for reference.
Job details
- Pay
- Windsor, Ontario Candidates: hourly salary scale ($30.00 - $35.00). *Other locations, salary to be discussed based on geographic differential.
- Job type
- Full-time
- Closing date
- Experience
- A minimum of 5-7 years experience in insruance claims handling, in medical claims handling, fraud investigation, or a related field.
- Posting language
- English
- Posted
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Search current openingsOriginal job description
Archived listing. The details below describe a past opening.
Job Description
We are looking for detail-oriented, analytical, and proactive Claim Fraud Analysts to join our fraud detection and prevention team. As part of our dynamic team, you'll have the opportunity to make a real impact by helping prevent fraudulent activities and ensuring that our clients' claims are handled with the highest level of integrity. Join us in our mission to protect and serve our clients while advancing your career in a fast paced and supportive environment.
Role And Responsibilities
If you require assistance or accommodation during our recruitment process, please notify Human Resources so that we can review and consider how we may be able to assist you based on your individual needs.
We offer you
Global Excel offers more than a position
We are looking for detail-oriented, analytical, and proactive Claim Fraud Analysts to join our fraud detection and prevention team. As part of our dynamic team, you'll have the opportunity to make a real impact by helping prevent fraudulent activities and ensuring that our clients' claims are handled with the highest level of integrity. Join us in our mission to protect and serve our clients while advancing your career in a fast paced and supportive environment.
Role And Responsibilities
- Analyze insurance claims for signs of fraud or suspicious activity.
- Conduct thorough investigations to verify the legitimacy of claims, including interviews, evidence collection, and surveillance.
- Identify patterns of fraud, track emerging trends, and work to uncover fraudulent schemes.
- Review claim data to spot anomalies or red flags.
- Utilize fraud detection tools, software, and databases to assist in identifying fraudulent claims.
- Maintain accurate records of findings and investigations for legal or compliance purposes.
- Work closely with claims assessors, investigators and legal team when required.
- Communicate findings, collaborate with other departments and escalate potential fraud cases and trends to key stakeholders and management.
- Provide training to claims staff on fraud detection techniques and red flags.
- Prepare detailed reports on investigations, findings, and recommendations.
- Ensure that investigations comply with industry regulations, company policies, and legal standards.
- Keep up to date with fraud-related legislation and best practices.
- Maintain organized and up-to-date case files, ensuring compliance with regulatory requirements.
- Propose and implement measures to reduce fraud risk, including process improvements and enhanced fraud detection methods.
- Assist in the development of fraud prevention programs and initiatives for the company.
- Data accuracy and integrity
- Scope of potential fraud cases to identify and monitor
- Manual Discovery Processes -System Limitations
- Complex data sets
- Analytics support
- Trend Analysis
- Continuous Improvement
- Educate employees
- Accuracy of Analysis- Reliability of the data analysis and conclusions.
- Stakeholder Satisfaction- Positive feedback from partners on the quality and usefulness of analyses and recommendations.
- Impact of Recommendations- The effectiveness of implemented recommendations in improving processes affecting outcomes.
- Continuous Improvement.
- A minimum of 5-7 years experience in insruance claims handling, in medical claims handling, fraud investigation, or a related field.
- Bachelor’s degree or equivalent relevant experience
- Strong investigative skills, critical thinking and attention to detail.
- Technical proficiency and a thorough understanding of data analysis software, fraud detection systems and cybersecurity measures.
- Familiarity with machine learning and artificial intelligence.
- Familiarity with financial regulatory compliance and insurance industry standards.
- Strong written and verbal communication skills.
- Excellent communication skills in English and French (French is considered an asset) English will be used in particular to carry out daily follow-ups with other departments in our various offices, whether in Ontario, or elsewhere.
- Full proficiency in Microsoft Office Suite with advanced Excel and Database skills.
- Familiarity with claims management processes and insurance industry standards.
- Analytical skills to interpret complex data sets.
- Strong communication skills to present findings clearly to stakeholders.
- Problem-solving skills to identify and address issues in data and processes.
- Ability to work independently and as part of a team.
- Ability to manage multiple tasks and prioritize effectively.
- Ability to adapt to changing requirements and environments.
- Detail-oriented with the ability to apply critical thinking to ensure a commitment to accuracy.
- Proactive and self-motivated.
- Continuous learner and curiosity; staying updated with industry trends and best practices.
- Ethical judgement and integrity.
If you require assistance or accommodation during our recruitment process, please notify Human Resources so that we can review and consider how we may be able to assist you based on your individual needs.
We offer you
Global Excel offers more than a position
- Competitive compensation package that includes a base salary, annual salary review and annual performance bonus;
- Extensive benefit package including, health, dental, travel and health care spending account;
- 3 weeks vacation;
- RRSP matching program;
- A professional future with opportunities for development, growth, and advancement;
- Financial assistance to employees who wish to continue their education;
- Work/life balance, health and wellness initiatives including an excellent Employee Assistance program;
- On site Gym;
- Employee engagement programs that focus on fitness, food, and fun;
- Windsor, Ontario Candidates: hourly salary scale ($30.00 - $35.00). *Other locations, salary to be discussed based on geographic differential.
More about this job
Responsibilities
Investigate insurance claims for potential fraud by analyzing data, identifying suspicious patterns, gathering evidence, and documenting findings in detailed reports. Collaborate with claims, legal, and other teams to escalate cases, support fraud prevention initiatives, improve detection processes, and educate staff.
Requirements
Requires 5–7 years of experience in insurance claims handling, medical claims, fraud investigation, or a related field, plus a bachelor’s degree or equivalent relevant experience. Candidates should have strong investigative and analytical abilities, advanced Excel and database skills, familiarity with fraud detection technology and insurance compliance, and excellent English communication skills; French is an asset.
Skills
- Insurance Claims Analysis
- Fraud Investigation
- Data Analysis
- Trend Analysis
- Evidence Collection
- Surveillance
- Critical Thinking
- Attention To Detail
- Fraud Detection Systems
- Microsoft Excel
- Database Skills
- Regulatory Compliance
- Claims Management
- Report Writing
- Stakeholder Communication
- Process Improvement
Benefits
- Annual Performance Bonus
- Health Insurance
- Dental Insurance
- Travel Benefits
- Health Care Spending Account
- Three Weeks Vacation
- RRSP Matching Program
- Professional Development Opportunities
- Education Assistance
- Work-Life Balance Initiatives
- Health and Wellness Initiatives
- Employee Assistance Program
- On-Site Gym
- Employee Engagement Programs
Visa sponsorship
Not detected in the job text
Categories
- Finance & Accounting
- Data & Analytics
- Legal
- Security & Safety
Keywords
- Insurance Claims
- Medical Claims
- Fraud Investigation
- Fraud Detection
- Fraud Prevention
- Claims Management
- Data Analysis
- Trend Analysis
- Anomaly Detection
- Evidence Collection
- Surveillance
- Fraud Detection Software
- Fraud Detection Systems
- Machine Learning
- Artificial Intelligence
- Cybersecurity
- Microsoft Office Suite
- Microsoft Excel
- Databases
- Regulatory Compliance
- Insurance Industry Standards
- Financial Regulations
- Case Files
- Investigation Reports
- Process Improvement
- Risk Reduction
- Stakeholder Communication
- Employee Training
- English
- French