● 招聘公司： 加拿大永明金融集团（Sun Life Financial）点击申请● 招聘职位： 药品索赔调查员（Drug Claim Investigator） ● 工作内容： - Detect and investigate any situation involving possible dishonest or fraudulent activities, member, sponsor and/or provider focused;
- Analyze claims usage reports to detect fraud and/or policy and claim abuse as requested by Account Executives and Plan Sponsors;
- Provide assistance to resolve allegations of fraud, conduct interviews and take statements from providers, plan sponsors, plan members and other parties;
- Collect and safeguard evidence, maintain databases and logs pertaining to investigations;
- Notify and collaborate with law enforcement and regulatory bodies;
- Remain current and up to date on industry trends, education, products, changes in scopes of practice, new drugs entering the market, and privacy laws;
- Provide expertise on health cases for Senior Management, the Ombudsman, Claims, Business Development and the Customer Care Centre;
- Develop and maintain effective working relationships with internal and external Clients as well as partners within the anti-fraud industry;
- Train and educate internal and external Clients on Sun Life Financial fraud controls.
● 工作要求： - 至少3年全职零售或医院药房技术员工作经验；
- 具有较强的处方和非处方药类型知识；
- 熟悉常用药物剂量、处方要求；
- 有优秀的谈判和决策技巧，能够独立完成指定的评审工作；
- 了解和理解适用于该行业的合同语言、行政指导方针、省和联邦立法；
- 掌握优秀的计算机软件应用技术，包括Microsoft Office (Word, Excel, Power Point, Access)；
- 具有法语和英语两种语言的专业水平。
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