Anti-Fraud Manager

Central Insurance Company•Van Wert, OH

11d•Hybrid

About The Position

Fraud prevention is at the heart of protecting our customers and our business—and that’s where this role makes an impact. As Anti-Fraud Manager, you’ll lead front-line investigative efforts, tackle complex and high-impact cases, and partner with a wide network of internal teams and external agencies. This is an opportunity to shape strategy, develop talent, and bring modern tools and analytics into real-world fraud detection and deterrence.

Requirements

Bachelor’s Degree in Criminal Justice, Criminology, or Fraud Management and 2 years relevant experience
Or 4 years of relevant SIU investigator/SIU Supervisor experience
SIU Supervisor needs to have significant knowledge and experience in all levels of P&C claim fraud investigation and reporting requirements to the various fraud bureaus.
Advanced practical knowledge of conducting medical and property investigations in the field is necessary
Good working knowledge of Word, Excel, and PowerPoint applications
Demonstrated ability to build and maintain collaborative relationships with internal and external partners and business areas.
Proven management skills
Ability to demonstrate monthly productive outcomes from investigations assigned to the SIU team
Excellent leadership, team building, communication and strategic thinking skills
Ability to prepare and present training sessions
Successful track record in facilitating and managing projects and teams
Attain and be very proficient at the SIU protocols and procedures that would include SIU compliance to the specific states the company operates in
Possess in-depth knowledge of insurance policies and procedures related to SIU investigations
Ability to understand Central Insurance’s policies and processes

Nice To Haves

Licensure & Certification: None required; One or more of the following certifications/designations are desirable: Senior Claims Law Associate Designation, Certified Insurance Fraud Investigator Designation, and Certified Fraud Examiners Designation.
Familiarity with anti-fraud analytics programs as it relates to fraud prevention and identification

Responsibilities

Supervises the day-to-day investigative activity of SIU field/desk investigations and support activities throughout regions.
Acts as the direct liaison with the various Claims Staff, Departments of Insurance and other regulatory agencies, NICB and other industry investigative representatives.
Monitors and evaluates the quality of performance and key results through ongoing audits and review of results of both direct adjuster and advanced cutting edge analytic referrals of both artificial intelligence and machine learning.
Reviews and evaluates all available information to assess the appropriateness of referrals for prosecution and/or recovery.
Ensures that all SIU investigation files include a concise and complete summary of the investigation, including the investigators findings regarding the suspected insurance fraud and the basis for their findings and ensure that all investigative cases are thoroughly, promptly, and efficiently investigated and referred to the proper authority within the timeframe as mandated.
Works with all members of the Claims Management, Underwriting and Marketing Teams, Claim Support Staff, Independent Vendors, Defense Counsel, and all other entities as may be required, to ensure effective implementation of fraud detection and deterrent protocols.
Assists with the training of Central Mutual Insurance anti-fraud personnel and Claims Staff in fraud detection, prevention, and suspect claim handling measures.
Represents the Company at various industry, state and local organizations which focus on anti-fraud activities.
Coordinates investigation of complex suspect claims and assignments as warranted ensuring proper resolution and documentation within case management system.
Collaborates with the SIU Director on all matters of the SIU function to include, but not limited to; investigation, investigative strategy, training and other department matters.
Oversees reporting of all suspected fraudulent insurance transactions to the appropriate departments of insurance within the required time frames for their team.
Establishes and maintains relationships with law enforcement, Department of Insurance officials and insurance industry personnel and assist them when required.
Selects, trains, and develops new employees
Sets expectations with regards to performance
Communicates with, motivate and recognize employees
Evaluates performance and conducts weekly check-ins and performance reviews
Manages staff and other resources appropriately