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GreenShield

INVESTIGATIVE ANALYST

Windsor, ON, Canada

$59,688 to $91,109 CAD / year · Contract

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Job details

Pay: $59,688 to $91,109 CAD / year
Job type: Contract
Apply by: Dec 4, 2026
Experience: Minimum of 5 years’ experience in audit and fraud detection, health care benefit administration and/or in conducting investigations.
Posting language: English
Posted: Nov 4, 2026

Original job description

THE ROLE IN A NUTSHELL

Base Salary: CAD $59,688.00 - 91,109.00

Investigation and Analysis

Support the delivery and evolution of the Claim Watch program, including identification and leading of complex and high‑risk investigations.
Leverage reporting and AI technology to identify, research, and analyze abuse, misuse, and fraudulent claims activity with a focus on emerging patterns and systemic risk.
Conduct complex interviews with providers and plan members and exercise independent judgment in ambiguous or precedent‑setting situations.
Analyze utilization trends and develop provider and plan member profiling criteria to support preventative and detective fraud controls, using reporting and AI tooling.
Identify and recommend cost‑containment and risk‑mitigation opportunities, including automation and control enhancements.
Develop and implement preventative fraud measures and support audit, compliance, and enterprise risk activities.
Collaborate across departments and with external stakeholders, including providers, associations, and law enforcement.
Produce executive-level reporting and analytics that translate complex investigative findings, emerging risks, and fraud trends into actionable business insights and strategic recommendations for leadership and clients.
Provide mentorship and guidance to investigative staff and contribute to continuous improvement of investigative practices.
Contribute to and analyze the development of investigative reporting requirements, dashboards, and performance metrics, identifying opportunities to improve visibility into fraud, abuse, misuse, operational effectiveness, and emerging risks.
Provide training and mentoring to peers and team members.
Support the client/partner specific Claim Watch governance framework.

WHO WE ARE LOOKING FOR

Minimum of 5 years’ experience in audit and fraud detection, health care benefit administration and/or in conducting investigations.
Demonstrated ability to exercise independent judgment and make defensible decisions in complex investigative scenarios.
Working knowledge with AI technology.
Exceptional analytical and critical-thinking skills with demonstrated ability to synthesize large and complex data sets, identify emerging patterns, assess risk, and translate findings into strategic recommendations.
Experience contributing to preventative fraud strategies, automation, or intelligent audit approaches (asset).
Demonstrated leadership, mentorship, and ability to influence outcomes across teams without direct authority.
Demonstrated commitment to continuous learning and professional development, with a strong curiosity for emerging technologies, fraud schemes, industry trends, data analytics, and investigative methodologies.
University degree or college diploma in business or related discipline required.
Strong interpersonal skills and the ability to communicate to all levels of internal and external customers both orally and written.
Understanding of group Health & Dental administration.
Excellent customer service with a drive to deliver exceptional service.
Demonstrated capability to meet objectives and milestones when working independently and on project teams.
Highly organized and able to balance multiple tasks in a fast-paced environment.
Working knowledge of relevant federal and provincial legislation, regulations and the judiciary system (Including but not limited to: PIPEDA, Regulated Health Professions Act, Privacy Act) would be an asset.
Proficiency with Microsoft Office tools, including Access, Excel, Word, and other business applications and reporting tools.
Experience using Business Intelligence (BI) and Data Visualization platforms.
Ability to travel within Canada.

GS supports diversity, equity and inclusion in our teams and communities, and we value the unique contributions made by all. Even if your experience doesn’t align perfectly to every requirement, we invite you to apply. We encourage applications from all candidates and will accommodate needs under human rights legislation throughout all stages of the recruitment and selection process. Please let us know of any accommodation through requestforaccommodation@greenshield.ca. Information received relating to accommodation will be addressed confidentially.

Providing this information gives GS consent to use your personal information to assess your suitability for specific positions, future opportunities or for your personnel file. Your résumé will be held in strict confidence and will be viewed only by the Organization. Information may be stored outside of Canada and could be used for aggregate statistical purposes (which uses no personal identification).

AI Usage - GreenShield leverages AI to help produce Job Descriptions, and ideate on interview questions. We also leverage AI for interview transcription support.

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More about this job

Responsibilities

Lead complex, high-risk investigations and use reporting, AI, and data analysis to identify fraud, abuse, misuse, emerging patterns, and systemic risks. Develop fraud controls and risk-mitigation recommendations, produce executive-level reporting, collaborate with internal and external stakeholders, and mentor investigative staff.

Requirements

Requires at least five years of experience in audit and fraud detection, health care benefit administration, and/or investigations, along with a business-related university degree or college diploma. Candidates should bring strong analytical and communication skills, independent judgment, working knowledge of AI and BI tools, and the ability to mentor others; knowledge of relevant legislation and experience with preventative fraud strategies are assets.

Skills

Fraud Detection
Investigations
Data Analysis
Risk Assessment
AI Technology
Business Intelligence
Data Visualization
Audit
Interviewing
Reporting
Microsoft Excel
Microsoft Access
Mentorship
Stakeholder Communication
Health and Dental Benefits Administration
Privacy and Regulatory Compliance

Visa sponsorship

Not detected in the job text

Keywords

Claim Watch
Fraud Detection
Complex Investigations
High-Risk Investigations
Health Care Benefit Administration
Group Health and Dental
Artificial Intelligence
Reporting
Data Analytics
Utilization Trends
Provider Profiling
Plan Member Profiling
Fraud Controls
Cost Containment
Risk Mitigation
Automation
Intelligent Auditing
Audit
Compliance
Enterprise Risk
Business Intelligence
Data Visualization
Dashboards
Performance Metrics
PIPEDA
Regulated Health Professions Act
Privacy Act
Microsoft Access
Microsoft Excel
Law Enforcement

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