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Senior LTC Investigator

John Hancock

John Hancock

Boston, MA, USA
Posted on Saturday, May 18, 2024

We are a leading financial services provider committed to making decisions easier and lives better for our customers and colleagues around the world. From our environmental initiatives to our community investments, we lead with values throughout our business. To help us stand out, we help you step up, because when colleagues are healthy, respected and meaningfully challenged, we all thrive. Discover how you can grow your career, make impact and drive real change with our Winning Team today.

Working Arrangement

Hybrid

Job Description

About The Role:

LTC is on a transformational journey. Being part of this transformation is exciting and offers hard-working, ambitious people an incredible opportunity to build a career. We value innovation and have a proven track-record, with a unique behavioral insurance offering that rewards customer for living a longer, healthier life.

We are looking for a candidate with an ex-law enforcement background with proven experience assessing data using AI to identify where suspicious activity/behavior exists during the claim process (claim initiation, submitting reimbursements). The candidate will be a leader with vision across multiple squads dedicated to 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/abuse within the LTC claims experience. You will partner with all squads to drive savings associated with fraud, waste & abuse.

The Senior 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 incumbent will also provide insights to Data and AI Team on how to evolve data and consider new data sources to drive a greater degree of fraud detection.

Individual Responsibilities:

  • Successfully completes high-quality internal investigations with recommendations to field investigators
  • Detects, investigates and prevents allegations of fraud, waste & abuse by, agents/brokers, customers, providers, POA and family members
  • Presents case findings to management for review and offers recommendations for further action
  • Gathers and verifies information from company systems, proprietary databases, Internet and other data sources
  • Obtains and reviews physical, documentary, and forensic evidence
  • Produces reports which are well-written, accurate, concise, and objective
  • Regularly communicates findings and investigation status
  • Completes special projects individually or as a team member
  • Maintains knowledge of current investigative techniques, company databases, Internet sources, proprietary database resources, and industry trends, Maintains and continuously expands network of professional contacts
  • Assists in the company fraud awareness training program and annual department training by helping to develop training materials
  • Performs all duties in strict compliance with department and company guidelines and policies

Job Requirements:

  • Bachelor’s degree in Criminal Justice or related field required
  • Experience with insurance fraud in Long Term Care or Disability a plus
  • Ex-law enforcement background is preferred
  • Five or more years of experience in the investigation profession
  • Effective written and verbal communication skills
  • Superior interviewing skills
  • Proficient in various computer applications (Excel, Access, PowerPoint)
  • Skilled in completing information searches of both the Internet and proprietary databases
  • Identify appropriate resources and investigative strategies
  • Responsible for developing plans and using proper techniques for investigations
    • Ability to apply a working knowledge of state laws and regulations related to insurance fraud and SIU requirements
    • Experience testifying in legal proceedings

What can we offer you?

  • A competitive salary and benefits packages.
  • Growth opportunities that extend upward and outward, encouraging you to develop and learn new skills.
  • A dedicated and supportive team environment.
  • Flexible work policies and 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.
  • Growth opportunities
    We create opportunities to learn and grow at every stage of your career.
  • Continuous innovation
    We invite you to help redefine delivery of best-in-class 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 partners and has a positive social and environmental impact.

#LI-Hybrid

#LI-JH

About Manulife and John Hancock

Manulife Financial Corporation is a leading international financial services group that helps people make their decisions easier and lives better. With our global headquarters in Toronto, Canada, we operate as Manulife across our offices in Asia, Canada, and Europe, and primarily as John Hancock in the United States. We provide financial advice, insurance, and wealth and asset management solutions for individuals, groups and institutions. At the end of 2022, we had more than 40,000 employees, over 116,000 agents, and thousands of distribution partners, serving over 34 million customers. At the end of 2022, we had $1.3 trillion (US$1.0 trillion) in assets under management and administration, including total invested assets of $0.4 trillion (US $0.3 trillion), and segregated funds net assets of $0.3 trillion (US$0.3 trillion). We trade as ‘MFC’ on the Toronto, New York, and the Philippine stock exchanges, and under ‘945’ in Hong Kong.

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.

Salary & Benefits

The annual base salary for this role is listed below.

Primary Location

Boston, Massachusetts

Salary range is expected to be between

$68,475.00 USD - $114,125.00 USD

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

Company: John Hancock Life Insurance Company (U.S.A.)