LTC Fraud Investigator

$68,475 - $114,125/Yr

Manulife - Boston, MA

Full-time - Mid Level

Boston, MA

Insurance Carriers and Related Activities

About the position

The Long-Term Care (LTC) Investigator plays a crucial role in identifying and preventing fraud, waste, and abuse within the LTC claims process. This position involves conducting complex investigations, collaborating with various teams, and utilizing advanced tools and techniques, including Machine Learning and AI, to enhance fraud detection efforts. The investigator will also support junior investigators and provide insights to improve data utilization for fraud prevention.

Responsibilities

• Successfully completes investigations with recommendations to internal Global Investigative & Forensic Services team to initiate field investigations and surveillance.
• Detects, investigates and prevents fraud, waste & abuse by agents/brokers, customers, providers, POA and family members.
• Presents case findings to management for review and offers next-step recommendations.
• Gathers and verifies information from systems, proprietary databases and OSINT findings.
• Obtains and reviews physical, documentary, and forensic evidence.
• Produces well-written, accurate, concise, and objective reports.
• Regularly communicates findings and investigation status.
• Completes special projects individually or as a part of an FWA team.
• Maintains knowledge of current investigative techniques, company databases, OSINT, proprietary database resources, and industry trends.
• Assists in the company fraud awareness training programs and annual department training by contributing to development of training materials.
• Performs all duties in strict compliance with department and company guidelines and policies.

Requirements

• Bachelor's degree in criminal justice or related field.
• Experience in insurance, Medicare, Long-Term Care or Disability fraud.
• Law enforcement (financial crimes, FBI) background preferred.
• Five or more years of experience in a related profession.
• Effective written and verbal communication skills.
• Proficient in various computer applications (Excel, Access, PowerPoint).
• Skilled in executing information searches of both the Internet and proprietary databases.
• Ability to apply a working knowledge of state laws and regulations related to insurance fraud and SIU requirements.

Benefits

• A competitive salary and benefits packages.
• A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.
• A focus on growing your career path with us.
• Flexible work policies and strong work-life balance.
• Professional development and leadership opportunities.