Investigative Advisor – Investigative Services

We are seeking a motivated and detail-oriented Investigative Advisor to join our Investigative Services team. In this role, you will be responsible for investigating suspicious activities related to health and dental claims. Drawing on your investigative skills and professional judgment, you will gather facts, analyze evidence, and support decisions aimed at protecting the integrity of our insurance programs.

Key Responsibilities

• Review referrals and information from internal and external sources regarding suspected fraud or abuse in health and dental claims;
• Analyze alerts generated by fraud detection tools to identify suspicious patterns and potentially fraudulent activities;
• Conduct thorough investigations by collecting evidence from plan members, service providers, internal systems, and other relevant sources, while maintaining objectivity throughout the process;
• Clearly and concisely document findings, provide recommendations, and prepare client reports;
• Contribute to continuous improvement initiatives for our investigative methods and fraud detection mechanisms;
• Ensure rigorous and professional follow-up on escalated cases;
• Promote fraud prevention among internal and external partners through awareness initiatives and strategic recommendations;
• Stay informed about emerging fraud trends, schemes, and industry best practices.

Qualifications

• University degree in a relevant field (e.g., criminology, finance, actuarial science, accounting);
• Minimum of 3 to 5 years of experience in auditing, investigation, insurance, healthcare, or financial services;
• Strong analytical and critical thinking skills;
• Ability to navigate uncertainty and make informed decisions based on limited information;
• Comfortable interpreting data, using analytical tools, and reviewing large volumes of transactions;
• Proven ability to communicate professionally and manage difficult conversations;
• Excellent writing skills, with the ability to produce structured, objective, and well-documented reports;
• Demonstrated professionalism and sound judgment when handling sensitive information;
• Ability to manage multiple investigations simultaneously and adapt to shifting priorities in a dynamic work environment;
• Capable of working independently and collaboratively, with a strong sense of responsibility and commitment;
• Excellent knowledge of French and English, both spoken and written.