We’re looking for a detail-oriented, analytical LTC Fraud Consultant to help strengthen our Long-Term Care (LTC) Fraud, Waste & Abuse (FWA) program. In this role, you’ll turn claims and operational data into insights that support investigations, surface emerging fraud trends, and improve processes and controls across the program.
Position Responsibilities:
- Lead targeted customer outreach to explain updated claim reimbursement controls, drive adoption, and support understanding and compliance.
- Spend approximately 60% of the role on the phone conducting customer outreach related to claim reimbursement controls, education, and support.
- Analyze LTC claims and provider billing patterns to identify potential fraud, waste, and abuse.
- Prepare data extracts, dashboards, and concise analytic summaries to support case development and investigations.
- Monitor and communicate emerging fraud schemes; help design mitigations, controls, and process improvements.
- Partner cross-functionally with investigators, clinical teams, and technology teams to improve fraud operations and detection capabilities.
- Gather and document business needs (requirements, user stories, process flows) for enhancements to fraud detection and case management tools.
- Support performance monitoring and reporting for the LTC FWA program, and contribute to continuous improvement across fraud operations.
Qualifications:
- 3–5 years of experience in Long-Term Care (LTC), healthcare/insurance business analysis, and/or Fraud, Waste & Abuse (FWA)
- Strong analytical and critical-thinking skills; able to interpret complex claims and operational data
- Ability to translate findings into clear artifacts (business requirements, user stories, process flows)
- Advanced Excel skills and comfort with large datasets; familiarity with SQL/SAS and/or BI tools (Power BI/Tableau) a plus
- Clear written and verbal communicator; able to work effectively with both technical and non-technical stakeholders while managing multiple priorities
- Experience with fraud investigations/SIU and familiarity with Medicaid and/or commercial LTC benefits and fraud/case management tools preferred
When you join our team:
- We’ll empower you to learn and grow the career you want.
- We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.
- As part of our global team, we’ll support you in shaping the future you want to see.
This posting supports an ongoing hiring initiative for existing and/or future vacancies.
About Manulife and John Hancock
Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit “>[email protected].
Referenced Salary Location
USA, Massachusetts – Full Time Remote
Working Arrangement
Remote
Salary range is expected to be between
$73,350.00 USD – $122,250.00 USD
Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance. The actual salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education/training. If you are applying for this role outside of the primary location, please contact “>personal information collection statement.