(M-555) | Bilingual Investigative Claims Representative

(M-555) | Bilingual Investigative Claims Representative

10 Nov
Sun Life Financial

10 Nov

Sun Life Financial


You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

Job Description:

The Investigative Claims Representative (ICR)

is an important front line of defence in identifying potentially fraudulent activity submitted through Group Benefit plans. ICRs verify claims that require further handling by Health and Dental or Fraud Risk Management, by performing pre-and post-payment claim verifications on a selection of submitted claims through a variety of submission channels. This is achieved by placing outbound telephone calls to service providers, facilities and members in order to validate these submissions. The team also receives incoming telephone calls through the FRM Tip Line, from the public, with information regarding possible suspicious activities.

What will you do?

Contacting Plan Members, Service Providers and Hospitals to validate claim submission details including service dates, amounts, and type of service rendered or purchased.

Managing caseload and queue volumes, continually working towards first call resolution

Communicating with members, practitioner and hospitals utilizing the principles of clear language, and in a courteous and professional tone

Following up with requests for additional information from the Plan Member or Service Provider when verification cannot be obtained

Tracking and determining call outcomes

Collaborating with colleagues to drive process improvements, which have a direct impact on the client experience

What do you need to succeed?

Fully Bilingual (French and English)

Excellent verbal and written communication skills

Strong analytical and problem solving skills, and attention to accuracy and details

Strong organizational and decision making skills

Ability to complete detailed tracking of all activities to support any follow up

Ability to handle conflicting priorities and meet stringent deadlines

Ability to operate effectively as a team member in a dynamic environment

Ability to work independently with minimal supervision

Microsoft Excel experience

Post-secondary education preferred

Experience having worked in a serviced based organization

What's in it for you?

Joining a reputable organization with over 150 years of history

Being a member of the Sun Life family, a group of people united by our Purpose: to help Clients and Employees achieve lifetime financial security and live healthier lives

An environment of continuous learning and improvement

The Base Pay range is for the primary location for which the job is posted. It may vary depending on the work location of the successful candidate or other factors. In addition to Base Pay, eligible Sun Life employees participate in various incentive plans, payment under which is discretionary and subject to individual and company performance. Certain sales focused roles have sales incentive plans based on individual or group sales results.

Diversity and inclusion have always been at the core of our values at Sun Life. A diverse workforce with wide perspectives and creative ideas benefits our clients, the communities where we operate and all of us as colleagues. We welcome applications from qualified individuals from all backgrounds.

Persons with disabilities who need accommodation in the application process or those needing job postings in an alternative format may e-mail a request to [email protected]

We thank all applicants for showing an interest in this position. Only those selected for an interview will be contacted.

Salary Range:

34,000/34 000 - 49,000/49 000

Job Category:

Customer Service / Operations

Posting End Date:


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