What are the responsibilities and job description for the LTC Fraud Consultant position at manulife?
We’re looking for a detail-oriented, analytical LTC Fraud Consultant to help strengthen our Long-Term Care (LTC) Fraud, Waste & Abuse (FWA) program. In this role, you’ll turn claims and operational data into insights that support investigations, surface emerging fraud trends, and improve processes and controls across the program. Position Responsibilities: Lead targeted customer outreach to explain updated claim reimbursement controls, drive adoption, and support understanding and compliance. Spend approximately 60% of the role on the phone conducting customer outreach related to claim reimbursement controls, education, and support. Analyze LTC claims and provider billing patterns to identify potential fraud, waste, and abuse. Prepare data extracts, dashboards, and concise analytic summaries to support case development and investigations. Monitor and communicate emerging fraud schemes; help design mitigations, controls, and process improvements. Partner cross-functionally with investigators, clinical teams, and technology teams to improve fraud operations and detection capabilities. Gather and document business needs (requirements, user stories, process flows) for enhancements to fraud detection and case management tools. Support performance monitoring and reporting for the LTC FWA program, and contribute to continuous improvement across fraud operations. Qualifications: 3–5 years of experience in Long-Term Care (LTC), healthcare/insurance business analysis, and/or Fraud, Waste & Abuse (FWA) Strong analytical and critical-thinking skills; able to interpret complex claims and operational data Ability to translate findings into clear artifacts (business requirements, user stories, process flows) Advanced Excel skills and comfort with large datasets; familiarity with SQL/SAS and/or BI tools (Power BI/Tableau) a plus Clear written and verbal communicator; able to work effectively with both technical and non-technical stakeholders while managing multiple priorities Experience with fraud investigations/SIU and familiarity with Medicaid and/or commercial LTC benefits and fraud/case management tools preferred When you join our team: We’ll empower you to learn and grow the career you want. We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words. As part of our global team, we’ll support you in shaping the future you want to see. This posting supports an ongoing hiring initiative for existing and/or future vacancies. 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 hr@manulife.com. Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary range is expected to be between $73,350.00 USD - $122,250.00 USD Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance. 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. If you are applying for this role outside of the primary location, please contact hr@manulife.com for the salary range for your location. 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. We use data and analytics technologies, such as artificial intelligence (AI), and automated processing tools, to analyze and process the information you provide to us or third parties in the application process. For more information, please refer to our personal information collection statement. Know Your Rights I Family & Medical Leave I Employee Polygraph Protection I Right to Work I E-Verify Company: John Hancock Life Insurance Company (U.S.A.) We're Manulife. And we’re on a mission to make decisions easier and lives better. Better is what drives us. It’s what inspires us to find new ways to support customers and colleagues in living longer and healthier lives. It’s the reason we’re dedicated to investing in digital innovation and accelerating a sustainable and economically inclusive future. Joining us means you’ll be empowered to learn and grow your career. We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words. And as part of our global team, you’ll help shape the future you want to see – and discover that better can take you anywhere you want to go. We’re proud of our accomplishments and recognitions. Recent awards include: 2024 Gallup Exceptional Workplace Award Winner Manulife Named one of Forbes World’s Best Employers 2023 Best Companies to Work for in Asia 2023 We’ve been recognized as one of Canada’s Top 100 Employers (2024) Manulife included in Bloomberg’s 2023 Gender-Equality Index To receive our latest job opportunities directly to your inbox, create an account or sign in and navigate to the ‘Job Alerts’ section located in the top right corner of the page. From there, you can sign up to receive job alerts. Our ambition is to be the most digital, customer-centric global company in our industry. Learn more at https://www.manulife.com/.