LTC Fraud Investigator

The Long-Term Care (LTC) business is on a transformational journey. Being part of this transformation is exciting and offers talented, ambitious people an amazing opportunity to build their JH careers.

We are looking for a candidate with experience in insurance, Medicare, Long-Term Care or Disability fraud with expertise assessing and investigating suspicious activity / behavior during the claim process.

The candidate will be a thought leader identifying and preventing suspicious fraud activity in our US Long-Term Care business using tools, controls and Machine Learning / AI techniques and solutions to detect, capture and proactively prevent fraud, waste & abuse within the LTC claims process. You will partner with all squads to drive savings associated with fraud, waste & abuse. The LTC Investigator will conduct desktop investigations of high complexity related to LTC customers on claim. They will assist and support junior investigators on complex cases. The successful candidate will also provide insights to Data and AI Team on how to evolve data and consider new data sources to drive fraud detection.

Individual 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. Maintains and continuously expands network of professional contacts.

• 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

What are we looking for:

• 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

What motivates you?

• You obsess about customers, listen, engage and act for their benefit.

• You think big, with curiosity to discover ways to use your agile approach and enable business outcomes.

• You thrive in teams and enjoy getting things done together.

• You take ownership and build solutions, focusing on what matters.

• You do what is right, work with integrity and speak up.

• You share your humanity, helping us build a diverse and inclusive work environment for everyone.

What can we offer you?

• 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.

Our commitment to you

• Values-first culture
  We lead with our Values every day and bring them to life together.

• Boundless opportunity
  We create opportunities to learn and grow at every stage of your career.

• Continuous innovation
  We invite you to help redefine the future of financial services.

• Delivering the promise of Diversity, Equity and Inclusion
  We foster an inclusive workplace where everyone thrives.

• Championing Corporate Citizenship
  We build a business that benefits all stakeholders and has a positive social and environmental impact.

About Manulife and John Hancock

Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit https://www.manulife.com/en/about/our-story.html.

Manulife is an Equal Opportunity Employer

At Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.

It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact recruitment@manulife.com.

Primary Location

Salary range is expected to be between

If you are applying for this role outside of the primary location, please contact recruitment@manulife.com for the salary range for your location. The actual salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education/training. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.

Manulife/John Hancock offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans. We also offer eligible employees various retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in the U.S. includes up to 11 paid holidays, 3 personal days, 150 hours of vacation, and 40 hours of sick time (or more where required by law) each year, and we offer the full range of statutory leaves of absence.

Know Your Rights I Family & Medical Leave I Employee Polygraph Protection I Right to Work I E-Verify I Pay Transparency