This position is responsible for developing strategies to detect situations of possible and actual insurance and financial fraud committed by external stakeholders. The Compliance Fraud Investigator leads complex investigations into fraud allegations, which may include; premium fraud, claim fraud, service provider billing fraud, and organized fraud. This position prepares and participates in the civil and criminal legal process acting as WCB's representative on external fraud cases.
Leads complex investigations into potential fraud and financial crimes committed against the WCB by external stakeholders. This activity includes: developing investigation plans; providing leadership and direction to Compliance Officers assigned to the case; gathering and analyzing data from multiple sources; conducting interviews and obtaining statements from all relevant parties including workers, employers, WCB staff, police or other regulatory agencies; and determining course of action such as laying charges, pursing civil action or other sanctions.
Prepares investigative findings reports which are used to: lay criminal charges; initiate civil litigation; recover monies wrongly paid out as a result of the fraud; inform Internal Audit of fraud risks/vulnerabilities faced by the WCB; lay complaints with professional organizations of member misconduct; make compensation/ entitlement decisions by Compensation Services; inform WCB management on deficiencies of existing practices/policies that create opportunities for fraud; and initiate other investigations by WCB or other agencies (where appropriate and allowed by law). Acts as a subject matter expert to establish, calibrate and implement proactive fraud detection indicators.
Provides expertise on fraud/financial crime detection and investigation to department leadership and Compliance Officers.
Supports and educates WCB staff in understanding fraud detection and prevention measures.
Participates in the civil or criminal legal process including preparation of court documentation required to lay charges under the Criminal Code and The Act and to compel production of witnesses and documentation; acts as WCB's representative in testifying as required. Builds alliances, professional relationships and partnerships with financial crimes investigators from the police agencies and other investigatory bodies in order to provide or share information related to wrongdoing and fraud related matters and to achieve WCB objectives for compliance.
Pursues professional and personal development through continuing education and training, literature reviews, and workshops, seminars, etc to ensure continued expertise.
Performs other related duties as assigned.
Three (3) year university degree in Criminal Justice, Social Sciences, Law or related discipline
Minimum six (6) years experience leading complex insurance fraud or tax evasion investigations
Working knowledge of accounting principles and practices
Knowledge of the Canadian legal system and its procedures related to criminal prosecutions, rules of evidence, and civil legal proceedings
Proficiency in the use of personal computers and software in a Windows environment
Well-developed research, analytical and numeracy skills including the ability to obtain, assess and evaluate complex data to support decisions
Excellent verbal and written communication skills including and presentation/public speaking skills
Superior investigatory, interviewing, negotiating and/or audit skills
Strong interpersonal skills with demonstrated ability to remain objective and to utilize tact and discretion in dealing with contentious decisions, confidential information, complex issues, and confrontational contacts
Ability to organize and prioritize work load while managing multiple demands
Ability to work independently and collaboratively in a team environment with multiple stakeholders
Ability to obtain and maintain a level of security required for this job
Ability to travel in Manitoba
A Certified Fraud Examiners (CFE) or a Certified Insurance Fraud Investigator (CIFI) designation would be an asset
The salary range for the position is: $67,679 - $84,600 per annum.
A satisfactory criminal record check and verification of education will be required for the successful candidate.
The WCB is committed to building a skilled, diverse workforce with equitable representation of Aboriginal persons, visible minorities, persons with disabilities and women. Applicants are encouraged to indicate in their covering letter or resumé if they are a member of these groups.
During the WCB's assessment, interview, or hiring process, accommodations are available upon request.
The Workers Compensation Board of Manitoba is an injury and disability insurance system for workers and employers in Manitoba. We promote safe and healthy workplaces, recovery and return to work, and provide compassionate and supportive compensation services for workers and employers. Our vision is “A trusted partner, insuring today and building a safer tomorrow.”