Fraud Consultant - LTC Fraud, Waste & Abuse

Manulife • Usa, MA

10h • $73,350 - $122,250 • Remote

About The Position

Help protect our customers and the integrity of our Long-Term Care (LTC) business as an LTC Fraud, Waste & Abuse (FWA) Consultant on our growing investigative team. If you’re sharp on details, energized by complex puzzles, and comfortable turning ambiguity into clear next steps, you’ll thrive here. In this role, you’ll review LTC claims, spot suspect behaviors within the active claim block, and help shape investigation strategies that reduce fraud, waste, and abuse. You’ll work closely with your Manager and partner with Legal, Claims, Operations, and Global Investigative & Forensic Services (GIFS) when cases require escalation or formal review. This is a strong fit for an investigator or LTC claims professional who likes problem-solving, weighing complex fact patterns, and making defensible decisions. You’ll collaborate across FWA teams, working alongside Pilots and Investigative Consultants, to ensure the right investigative action is taken at the right time. Put simply: you’ll work on some of our most time-sensitive, high-impact cases involving potential suspicious activity.

Requirements

• Bachelor’s degree with 3+ years’ experience in LTC claims, including strong knowledge of LTC products, processes, regulations, and systems; experience in insurance fraud/SIU/complex claims preferred.
• Highly detail-oriented; proven ability to detect discrepancies across criminal data, medical/clinical information, and financial records.
• Superior written and verbal communication skills; able to tailor complex findings for customers, counsel, investigators, and executive stakeholders.
• Strong critical thinking and execution; able to manage a high-volume, variable caseload, set priorities, and apply claim management/SIU best practices.

Nice To Haves

• Bilingualism (English and French) is an asset. If the successful candidate is in Québec, proficiency in both languages will be required to support clients from various provinces outside of Quebec.
• Fraud credentials (e.g., CAMS, CFE, AHFI, FCLS) a plus; working knowledge of advanced analytics/AI, case management systems/BI tools; experience presenting to governance bodies and supporting audits or regulatory inquiries.

Responsibilities

• Review LTC claims to identify fraud, waste, and abuse indicators using pattern recognition, documentation validation, and behavioral red flags.
• Manage a high-volume investigative caseload while influencing change; partner with fraud squads to strengthen digital controls and advance fraud prevention/detection strategies.
• Conduct end-to-end investigations by gathering proof of payment/financial records, reviewing medical/clinical information, researching claimants and providers, and evaluating surveillance/third-party data.
• Monitor investigative trends using tools such as LEAF, Archer, and advanced analytics; provide data-driven recommendations to improve detection and prevention.
• Prepare clear, evidence-based case summaries and well-documented investigative files that meet internal quality standards, regulatory expectations, and chain-of-custody requirements; recommend next steps and additional evidence needed.
• Draft claimant communications (with Manager approval) and partner with Claims, Legal, Operations, and GIFS to support escalations and present fact patterns to governance bodies (e.g., FWA Fraud Council).
• Track and document case outcomes and savings; contribute to continuous improvement by enhancing investigative standards, procedures, and playbooks and identifying emerging LTC fraud schemes/typologies.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level