WHO WE ARE

GreenShieldis a proudly Canadian, national non-profit health care and insuranceorganization, driven by our mission of Better Health for All.We believe health care is aright, not a privilege, and we are committed to improving health outcomes,advancing health equity, and building a future where every Canadian can reachtheir full health and well-being potential.

Throughour unique integrated payer-provider ("payvider") model, we offerinsurance, administer benefits, and pay claims as a ‘payer’ while offeringhealth care services such as mental health, pharmacy, telemedicine, and chronicdisease management as a ‘provider’. As a non-profit social enterprise without shareholders, we reinvest our excessearnings to directly support underserved communities. Through GreenShieldCares, we positively impacted the health and well-being of over one millionCanadians between 2020 and 2025. What’s driving us now is the commitment to measurably impact an additionalthree million Canadians by 2030 – across mental health, essential medicines,and chronic disease management – through scalable initiatives that delivermeaningful change in pursuit of our mission of Better Health for All.

AtGreenShield, our culture is where purpose meets passion and performance. Our teams work as one to delivermeaningful, measurable impact for the people and communities we serve.

THEROLE IN A NUTSHELL

Base Salary: CAD $59,688.00 - 91,109.00

Investigation andAnalysis

- Support the delivery and evolution of the Claim Watch program, including identification and leading of complex and high‑risk investigations.
- Leverage reporting and AI technology to identify, research, and analyze abuse, misuse,



and fraudulent claims activity with a focus on emerging patterns and systemic risk.
- Conduct complex interviews with providers and plan members and exercise independent judgment in ambiguous or precedent‑setting situations.
- Analyze utilization trends and develop provider and plan member profiling criteria to support preventative and detective fraud controls, using reporting and AI tooling.
- Identify and recommend cost‑containment and risk‑mitigation opportunities, including automation and control enhancements.
- Develop and implement preventative fraud measures and support audit, compliance, and enterprise risk activities.
- Collaborate across departments and with external stakeholders, including providers, associations, and law enforcement.
- Produce executive-level reporting and analytics that translate complex investigative findings, emerging risks, and fraud trends into actionable business insights and strategic recommendations for leadership and clients.
- Provide mentorship and guidance to investigative staff and contribute to continuous improvement of investigative practices.
- Contribute to and analyze the development of investigative reporting requirements, dashboards, and performance metrics, identifying opportunities to improve visibility into fraud, abuse, misuse, operational effectiveness, and emerging risks.




- Provide trainingand mentoringto peers and team members.
- Support the client/partner specific ClaimWatch governance framework.

WHO WE'RE LOOKING FOR

- Minimum of5years’ experience in audit and fraud detection, health care benefit administration and/or in conducting investigations.
- Demonstrated ability to exercise independent judgment and make defensible decisions in complex investigative scenarios.
- Working knowledge with AI technology.
- Exceptional analytical and critical-thinking skills with demonstrated ability to synthesize large and complex data sets, identify emerging patterns, assess risk, and translate findings into strategic recommendations.
- Experience contributing to preventative fraud strategies, automation, or intelligent audit approaches (asset).
- Demonstrated leadership, mentorship, and ability to influence outcomes across teams without direct authority.
- Demonstrated commitment to continuous learning and professional development, with a strong curiosity for emerging technologies, fraud schemes, industry trends, data analytics, and investigative methodologies.
- University degree or college diploma in business or related discipline required.
- Strong interpersonal skills and the ability to communicate to all levels of internal and external customers both orally and written.
- Understanding of group Health & Dental administration.
- Excellent customer service with a drive todeliver exceptional service.
- Demonstrated capability to meet objectives and milestones when working independently and on project teams.
- Highly organized and able to balance multiple tasks in a fast-paced workplace.
- Working knowledge of

📌 INVESTIGATIVE ANALYST (Toronto)
🏢 Green Shield Canada (GSC)
📍 Toronto