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Job Description:
Fraud management is increasingly important to policyholders. To serve Sun Life’s clients as industry leaders, Canadian Operations’ Fraud Risk Management area will identify, mitigate and respond to criminal threats using various tools, technologies and strategies.
Reporting to the Manger for Fraud Risk Management (FRM), the Dental Investigator will be responsible for fraud detection, prevention, and investigation into extended health care benefits fraud across Canada. Using data analytics, advanced interviewing skills and investigative excellence, the successful candidate will focus on the identification and investigation of situations involving dishonest, fraudulent, and abusive claiming involving dental providers, clinics, and plan members.
Investigations require regular contact with external stakeholders including plan members, dental providers, associations, and colleges. The Dental Investigator will be required to present findings, file regulatory complaints, prepare police cases, and give evidence at regulatory, civil and/or judicial hearings.
What will you do?
Identify high-risk areas of fraud and abuse in the dental landscape and make recommendations to address control gaps and continuous improvement.
Investigate situations of fraud and/or abuse with a focus on dental providers, clinics, and plan members.
Identify trends, report on issues and suggest appropriate actions to internal and external stakeholders.
Conduct plan member and provider interviews.
Make quick-thinking and decisive decisions when handling files.
Prepare documentation, such as investigation reports, management briefings, or other communications in a professional, confident and proficient manner.
Research, gather data, and present findings in a variety of settings and to a variety of internal and external stakeholders, including clients, service providers, Legal, internal business partners and senior management.
Prepare for and participate in regulatory, civil and/or judicial hearings to resolve investigations.
Keep up to date on industry trends and schemes impacting benefit plans.
What do you need to succeed?
Minimum of two years dental industry expertise attained through experience as a dental hygienist, dental assistant, dental office manager, or other related profession.
Strong knowledge of dental terminology and expense codes.
Knowledge of dental insurance benefits and regulatory environments.
Understanding of interviewing and investigative principles and practices.
Strong research and analysis skills.
Understanding of contractual language, administration guidelines, and provincial and federal legislation applicable to the industry.
Strong decision-making skills and innovative thinking.
Ability to effectively negotiate and influence.
Adaptable to a fast-paced environment and can work well independently and collaboratively.
Strong analytical skills with attention to accuracy and details.
Advanced Microsoft Office skills (Word, Excel, PowerPoint, Outlook), specifically Excel (experience with pivot tables)
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.
Preferred Skills:
Previous dental audit / investigation / interviewing experience.
University degree or post-secondary education is an asset.
Experience with Tableau is an asset
Unique requirements:
This position can be based in Montreal, Waterloo or Toronto with occasional travel.
As a condition of the role, the successful candidate must obtain a Government of Canada Reliability Status security clearance through Sun Life.
What's in it for you?
Hybrid work environment
A friendly, collaborative, and inclusive culture
15 vacation days per year
Flexible Benefits from the day you join to meet the needs of you and your family
Pension, stock and savings programs to help build and enhance your future financial security
The opportunity to move along a variety of career paths with amazing networking potential
Access to our Global Learning Centre, available 24/7 for your learning needs
Wellness programs that support the three pillars of your health – mental, physical and financial
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 thebrightside@sunlife.com.
We are proud to be a hybrid organization that offers our employees the choice and flexibility to work from both the office and virtually based on the needs of the business, our Clients and you! Several 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:
58,000/58 000 - 93,000/93 000Job Category:
Risk ManagementPosting End Date:
18/12/2025