Fraud Specialist

SGI•Weyburn, SK

1d•CA$90,116 - CA$120,147•Hybrid

About The Position

The Fraud Specialist supports the Enterprise Fraud Program and is accountable for governance, fraud risk management and quality assurance. This role establishes and maintains fraud standards, indicators, and escalation protocols to ensure a consistent approach to fraud management. This role contributes to the evolution of the fraud strategy, program enhancements and recommends policy and process changes. The Fraud Specialist leverages advanced detection tools, analytics, and industry partnerships to protect SGI and SGI CANADA from fraudulent activity, minimize financial losses, and safeguard honest policyholders. This role collaborates with internal teams, the Special Investigation Unit (SIU), law enforcement, and vendor networks to ensure suspected fraud is handled accurately, fairly, and efficiently.

Requirements

Four year degree from an accredited post-secondary education institution in a relevant field of study such as Business or Justice Studies.
Six years of experience in fraud risk management, law enforcement, investigations, or leadership in insurance claims; supplemented with experience in program implementation and oversite.
Knowledge of the insurance industry.
Knowledge of fraud prevention, detection, and investigation principles, methodologies and best practices.
Knowledge of relevant laws, regulations, and industry standards pertaining to fraud prevention and detection.
Knowledge of claims policies and procedures related to the adjustment and settlement of claims (auto, property and injury).
Knowledge of how business procedures and internal controls interact to support corporate operations.
Knowledge of fraud detection platforms (e.g., FRISS), Guidewire systems, and data analytics.
Knowledge of legal processes, including EUOs, regulatory compliance, and evidence handling.
Skill with data analysis and preparing concise reports.
Ability to build and maintain dynamic relationships with business partners, vendors, and other internal and external stakeholders.
Ability to communicate clearly, concisely and targeted to the audience.
Ability to collaborate and build support to drive change.

Responsibilities

Supports the Enterprise Fraud Program by leading in the implementation and maintenance of fraud prevention and detection measures, including policies, procedures, and controls in accordance with industry best practices and regulatory guidelines.
Establishes and maintains fraud standards, indicators, and escalation protocols to guide detection and response efforts.
Builds partnerships with internal teams, operational leadership, legal, and product management for fraud prevention and detection alignment and integration.
Leads the development, implementation, and use of advanced fraud detection tools/platforms and analytics, actively researches emerging trends and technologies to ensure continuous improvement and alignment with industry best practices.
Develops fraud thresholds, scoring calibrations, and validation methods to enhance detection accuracy.
Maintains awareness of industry developments and internal concerns and identifies emerging fraud risks, including but not limited to, Vehicle Identification Number (VIN) tampering, cloning, vehicle identity fraud, staged accidents, ghost broking, misrepresentation, and opportunistic fraud.
Partners with SIU to escalate complex files requiring litigation, EUO (Examination Under Oath), or external enforcement.
Conducts research and provides recommendations on the development, maintenance and execution of fraud strategy, program enhancements, resources planning, policy and process changes and risk mitigation strategies.
Collaborates with internal departments, such as SIU, FIU (Fraud Investigation Unit), Quality Assurance, Auto Fund, Underwriting, Corporate Insurance, Privacy, Risk management, Legal, and IT, to develop and implement fraud prevention strategies and controls.
Provides guidance and subject matter expertise to operational teams in collaboration with SIU, supporting investigation best practices and fraud awareness.
Monitors and identifies legislative and regulatory changes; assesses impact to fraud programs, collaborates and provides recommendations to leadership on next steps, and develops communications for operations and other impacted stakeholders.
Accountable for quality assurance, contributing to ongoing improvement by regularly reviewing fraud detection processes, analytics, and performance. Collaborates with internal stakeholders to implement corrective actions and continuous improvement initiatives based on findings, feedback, and performance metrics.
Collaborates with Corporate Training to develop and maintain a comprehensive package of employee training programs that raise awareness of fraud risks, educate on prevention techniques, and how to identify and report probable/potential fraud situations.
Fosters a culture of accountability and high standards in fraud prevention and detection, ensuring operational teams remain attentive and proactive.
Collaborates with Corporate Partnerships to monitor performance of preferred vendor networks (e.g., Tow Partners, Paintless Dent Repair, Body Shops) and identifies anomalies, overbilling, or misrepresentation.
Strengthens contract governance by actively identifying patterns of fraudulent claim involvement and supporting partnerships and operations in addressing repeated fraud related Master Service Agreement (MSA) breaches. Provides actionable intelligence to detect and substantiate non-compliance with rate schedules and service standards, enabling informed enforcement and remediation.
Recommends fraud mitigation measures for vendors and preferred partner management including audit controls and education.
Liaises with brokers, law enforcement, industry associations, and regulatory bodies to strengthen anti-fraud collaboration.
Engages with various communities and diverse stakeholders to build respectful relationships and promote fraud awareness and prevention.
Monitors fraud trends and produces reports for operational decision-making and strategic planning.
Prepares comprehensive fraud reports for internal and external purposes, including but not limited to: the nature and scope of suspected or confirmed fraudulent activity; patterns and methods of fraud detected; supporting evidence such as data analytics outcomes, claim file reviews, and interview summaries; identified fraud indicators or red flags; actions taken throughout the investigation; recommendations for escalation or mitigation; and potential financial and operational impacts. Ensures all documentation meets corporate standards, regulatory requirements, and maintains evidence integrity for enterprise-wide use.
Assists in developing key performance indicators (KPIs) and benefits realization measures for fraud mitigation initiatives.
Provides direction and guidance on the identification of analysis required, instructing the Fraud Analyst as needed for data, analysis and reporting.
Actively contributes to and supports a culture of a high performing workforce.
Participates in divisional succession plans, ensuring ongoing professional and career development and supports development in others.
Supports a culture of leadership and accountability to effectively deliver on strategic and corporate strategies.
Is actively committed to leadership development across the company, supporting team and workforce readiness through mentoring, training and developmental opportunities.
Enables the success of programs and policies that are in alignment with corporate, strategic and divisional strategies.
Manages risk in area of authority.
Ensures that the Health, Safety and Emergency Management Policy is applied in area of responsibility.