Director, LTC Fraud Strategy & Analytics
Manulife Financial, Boston, Massachusetts, us, 02298
The Long-Term Care Anti-Fraud, Waste, and Abuse Analytics Director serve as the voice of business and the customer for the fraud component of Claims focusing specifically on designing and developing controls. Accountable for driving new fraud control development which are integrated through the claims process (initiation through ongoing reimbursement), instituting transformational practices, tools, and AI solutions to prevent and detect controls proactively.
This role and the associated squads directed by this role play a critical component in the strategy, vision, outcomes, and key results by aligning and prioritizing business goals with actionable results. With that in mind, Bachelor’s or Master’s degree in Business Administration, Statistics, Mathematics, Data Science, Actuarial Science, or a related field is required. Candidates with other educational backgrounds may also be considered if they demonstrate strong business acumen in these areas. Equivalent combinations of education and experience will be considered for applicants with relevant, domain‑specific expertise.
The candidate will bring a senior-level strategic view and tactical delivery of products, tools, controls, and business processes aligned to fraud prevention and detection. The candidate is accountable for ideating and prioritizing the work across the Analytics and IT squads to design, test and execute data-driven strategies.
The ideal candidate will bring:
Strategic Vision:
Ability to connect the dots across multiple functional areas, anticipate capacity needs, and align team efforts with outcomes.
Operational Excellence : Proven ability to optimize processes, manage resources, and drive efficiency across complex workflows.
Analytical Acumen:
Strong analytical thinking with the ability to interpret data, identify trends, and translate insights into actionable controls.
AI & Data Science Fluency:
Familiarity with emerging technologies, including artificial intelligence, machine learning, and data science methodologies to inform decision-making and innovation.
Project Management Expertise:
Demonstrated success in leading cross-functional initiatives, managing timelines, budgets, and stakeholder expectations.
Leadership:
Energize and elevate the team and foster a culture of engagement and accountability. This individual should be able to prioritize the most valuable work and drive results. The ideal candidate will inspire trust, align the team around shared goals, and cultivate an environment where people feel valued, motivated, and empowered to contribute their best.
Executional Discipline:
Maintain and update key planning tools weekly such as roadmaps, JIRA boards, and status trackers, sponsor decks to ensure transparency, accountability, and momentum across teams.
Position Responsibilities
Drives the strategy, planning, prioritization, roadmap, and delivery of key Fraud capabilities with business partners.
Acts as a thought partner to business stakeholders on multi-million-dollar Fraud priorities.
Provide expert insights and recommendations to support strategic decision-making and risk management.
Stay updated on industry trends, emerging fraud schemes, and advancements in fraud detection technologies.
Collaborate with AI to design and develop predictive models to identify potential fraud.
Analyze large datasets to uncover patterns, anomalies, and trends indicative of fraudulent activities.
Identify cross-squad dependencies and impediments to achieving outcomes.
Collaborate with cross-functional teams, including data scientists, claims specialists, Call Center, and IT, to integrate fraud detection models into existing systems.
Collaborate with technical partners to monitor and evaluate model performance ensuring ongoing adjustments to improve detection rates and reduce false positives.
Mentor and guide junior team members, fostering a collaborative and innovative work environment.
Required Qualifications
Bachelor’s or Master’s degree in Business Administration, Statistics, Mathematics, Data Science, Actuarial Science, or a related field. Candidates with other educational backgrounds may also be considered if they demonstrate strong business acumen in these areas. Equivalent combinations of education and experience will be considered for applicants with relevant, domain‑specific expertise.
Minimum of 6 years of experience in the above-related field with a focus on long-term care insurance. Fraud prevention and detection preferred.
Strong proficiency in statistical software and programming languages such as R, Python, or SAS.
Experience with data visualization tools and techniques.
Excellent analytical, problem-solving, and communication skills.
Proven ability to lead projects and work collaboratively across departments.
When you join our team
We will empower you to learn and grow the career you want.
We will 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 will support you in shaping the future you want to see.
關於宏利和恒康 宏利金融公司是一家業界領先的國際金融服務商，致力於幫助人們實現「輕鬆投資理財，樂享豐盛人生」。若要進一步了解我們，請瀏覽 https://www.manulifeim.com/institutional/tw/en.
宏利是平等機會僱主 在宏利／恒康，我們擁抱多元。我們致力於吸引、培養及挽留和所服務客戶同樣多元的員工，並從而營造包容的工作環境，接納文化和個體差異。我們矢志維持公平的招聘、挽留、晉升及薪酬制度，我們管理的所有實踐及項目不會因種族、血統、原籍地、膚色、族裔、國籍、宗教或宗教信仰、信仰、性別（包括懷孕及其相關情況）、性取向、遺傳特徵、退伍軍人身份、性別認同、性別表達、年齡、婚姻狀況、家庭狀況、殘疾或受適用法律保護的任何其他因素而區別對待。
我們的首要任務是消除障礙，為員工提供平等就業機會。人力資源部代表將盡力為應徵過程中提出要求的申請人提供合理協助。申請人要求提供協助所分享的信息將會按照適用法律及宏利／恒康政策儲存及使用。應徵過程中如需協助，請聯絡 recruitment@manulife.com。
Referenced Salary Location Boston, Massachusetts
Working Arrangement 混合式
Salary range is expected to be between $128,550.00 USD - $222,820.00 USD
If you are applying for this role outside of the primary location, please contact recruitment@manulife.com for the salary range for your location. 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. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.
Manulife/John Hancock offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans. We also offer eligible employees various retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in the U.S. includes up to 11 paid holidays, 3 personal days, 150 hours of vacation, and 40 hours of sick time (or more where required by law) each year, and we offer the full range of statutory leaves of absence.
Know Your Rights I Family & Medical Leave I Employee Polygraph Protection I Right to Work I E-Verify
Company: John Hancock Life Insurance Company (U.S.A.)
#J-18808-Ljbffr
This role and the associated squads directed by this role play a critical component in the strategy, vision, outcomes, and key results by aligning and prioritizing business goals with actionable results. With that in mind, Bachelor’s or Master’s degree in Business Administration, Statistics, Mathematics, Data Science, Actuarial Science, or a related field is required. Candidates with other educational backgrounds may also be considered if they demonstrate strong business acumen in these areas. Equivalent combinations of education and experience will be considered for applicants with relevant, domain‑specific expertise.
The candidate will bring a senior-level strategic view and tactical delivery of products, tools, controls, and business processes aligned to fraud prevention and detection. The candidate is accountable for ideating and prioritizing the work across the Analytics and IT squads to design, test and execute data-driven strategies.
The ideal candidate will bring:
Strategic Vision:
Ability to connect the dots across multiple functional areas, anticipate capacity needs, and align team efforts with outcomes.
Operational Excellence : Proven ability to optimize processes, manage resources, and drive efficiency across complex workflows.
Analytical Acumen:
Strong analytical thinking with the ability to interpret data, identify trends, and translate insights into actionable controls.
AI & Data Science Fluency:
Familiarity with emerging technologies, including artificial intelligence, machine learning, and data science methodologies to inform decision-making and innovation.
Project Management Expertise:
Demonstrated success in leading cross-functional initiatives, managing timelines, budgets, and stakeholder expectations.
Leadership:
Energize and elevate the team and foster a culture of engagement and accountability. This individual should be able to prioritize the most valuable work and drive results. The ideal candidate will inspire trust, align the team around shared goals, and cultivate an environment where people feel valued, motivated, and empowered to contribute their best.
Executional Discipline:
Maintain and update key planning tools weekly such as roadmaps, JIRA boards, and status trackers, sponsor decks to ensure transparency, accountability, and momentum across teams.
Position Responsibilities
Drives the strategy, planning, prioritization, roadmap, and delivery of key Fraud capabilities with business partners.
Acts as a thought partner to business stakeholders on multi-million-dollar Fraud priorities.
Provide expert insights and recommendations to support strategic decision-making and risk management.
Stay updated on industry trends, emerging fraud schemes, and advancements in fraud detection technologies.
Collaborate with AI to design and develop predictive models to identify potential fraud.
Analyze large datasets to uncover patterns, anomalies, and trends indicative of fraudulent activities.
Identify cross-squad dependencies and impediments to achieving outcomes.
Collaborate with cross-functional teams, including data scientists, claims specialists, Call Center, and IT, to integrate fraud detection models into existing systems.
Collaborate with technical partners to monitor and evaluate model performance ensuring ongoing adjustments to improve detection rates and reduce false positives.
Mentor and guide junior team members, fostering a collaborative and innovative work environment.
Required Qualifications
Bachelor’s or Master’s degree in Business Administration, Statistics, Mathematics, Data Science, Actuarial Science, or a related field. Candidates with other educational backgrounds may also be considered if they demonstrate strong business acumen in these areas. Equivalent combinations of education and experience will be considered for applicants with relevant, domain‑specific expertise.
Minimum of 6 years of experience in the above-related field with a focus on long-term care insurance. Fraud prevention and detection preferred.
Strong proficiency in statistical software and programming languages such as R, Python, or SAS.
Experience with data visualization tools and techniques.
Excellent analytical, problem-solving, and communication skills.
Proven ability to lead projects and work collaboratively across departments.
When you join our team
We will empower you to learn and grow the career you want.
We will 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 will support you in shaping the future you want to see.
關於宏利和恒康 宏利金融公司是一家業界領先的國際金融服務商，致力於幫助人們實現「輕鬆投資理財，樂享豐盛人生」。若要進一步了解我們，請瀏覽 https://www.manulifeim.com/institutional/tw/en.
宏利是平等機會僱主 在宏利／恒康，我們擁抱多元。我們致力於吸引、培養及挽留和所服務客戶同樣多元的員工，並從而營造包容的工作環境，接納文化和個體差異。我們矢志維持公平的招聘、挽留、晉升及薪酬制度，我們管理的所有實踐及項目不會因種族、血統、原籍地、膚色、族裔、國籍、宗教或宗教信仰、信仰、性別（包括懷孕及其相關情況）、性取向、遺傳特徵、退伍軍人身份、性別認同、性別表達、年齡、婚姻狀況、家庭狀況、殘疾或受適用法律保護的任何其他因素而區別對待。
我們的首要任務是消除障礙，為員工提供平等就業機會。人力資源部代表將盡力為應徵過程中提出要求的申請人提供合理協助。申請人要求提供協助所分享的信息將會按照適用法律及宏利／恒康政策儲存及使用。應徵過程中如需協助，請聯絡 recruitment@manulife.com。
Referenced Salary Location Boston, Massachusetts
Working Arrangement 混合式
Salary range is expected to be between $128,550.00 USD - $222,820.00 USD
If you are applying for this role outside of the primary location, please contact recruitment@manulife.com for the salary range for your location. 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. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.
Manulife/John Hancock offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans. We also offer eligible employees various retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in the U.S. includes up to 11 paid holidays, 3 personal days, 150 hours of vacation, and 40 hours of sick time (or more where required by law) each year, and we offer the full range of statutory leaves of absence.
Know Your Rights I Family & Medical Leave I Employee Polygraph Protection I Right to Work I E-Verify
Company: John Hancock Life Insurance Company (U.S.A.)
#J-18808-Ljbffr