SIU Investigator
About The Position
Embark on a Journey That Makes a Difference. At Generali Global Assistance (GGA), every day is an opportunity to help people explore the world with confidence. Were not just in the business of protectionwere in the business of adventure and peace of mind. Whether its a backpacker trekking through the Andes, a family cruising the Mediterranean, or a solo traveler chasing the Northern Lights, were there to ensure their journey is safe and supported. From assisting with emergency medical claims to guiding customers through trip disruptions or ID theft, your work helps turn travel challenges into stories of resilience. Set Sail on a Career Path to Success. Our teams value curiosity and collaboration while priding ourselves on fostering a welcoming and inclusive atmosphere for our employees. Elevate your journey through our internal programs, including: Diversity, Equity, and Inclusion (DEI) Committee Career pathing and Individual Development Plans Internal training and intern opportunities Women in Business Mentorship Program Employee awards and recognition Education and professional development assistance program Passport to Perks Includes: Generous Employer contribution for health, dental, and vision insurance Paid Maternity and Paternity Leave Scholarship Program for Employee Dependents Company match on 401k Employee Assistance Program (EAP) Company paid short-term and long-term disability insurance Company paid life insurance Voluntary Pet Insurance Voluntary Legal Benefit Discounts on travel insurance Time off policies including vacation days, sick days, personal days, holidays and volunteer days (VTO) Your Role on the Expedition: Under direct supervision of the Anti-Fraud Program and Subrogation Manager, the SIU Investigator will become a key fraud referent for Claims Operations. This person will directly manage the most complex and high value fraud investigation providing regular feedback to the Claims teams. The SIU Investigator provides regular support to Claims Operations in the detection and analysis of suspicious cases while identifying new fraud scenarios. Additionally, this role will contribute to the quarterly fraud reporting completion. This person will collaborate with UDW, Actuarial and Finance teams in regard of identification of fraud patterns.
Requirements
- High School Diploma or Equivalent (GED) required.
- Minimum of 5 years of prior knowledge and experience in healthcare and/or insurance field for processing claims and or anti-fraud management.
- Strong analytical skills required including demonstrated ability to analyze raw data, draw conclusions, and develop actionable recommendations.
- Knowledge of developing standards, procedures, guidelines etc.
- Must be able to represent the organization in a professional and knowledgeable manner.
- Excellent verbal and written communication skills with ability to manage and prioritize multiple tasks.
- Computer skills necessary to work effectively: Windows Microsoft Word, Excel, and Power Point
- Proven ability to work under pressure, prioritize work and meet multiple deadlines.
- Excellent interpersonal and relationship building skills with a proven track record of leadership across functional lines that delivers business results.
- Excellent problem-solving skills and capability to troubleshoot the most difficult claim issues.
Nice To Haves
- Experience or demonstrated knowledge of travel insurance, travel assistance or health care/insurance preferred.
Responsibilities
- Triage and investigation of the most complex/high value alerts reported by Claims Ops.
- Collaborate with external Investigation Partners.
- Investigate Fraud patterns reported by other departments: UDW / Actuarial / Finance Teams
- Identify suspicious cases / fraud patterns by your own, leveraging data analysis.
- Support in the detection/triage phases.
- Support in the Deny process.
- Contribute to the definition of manual detection procedures in close collaboration with Claims Supervisors/ Managers.
- Identify new fraud scenarios for fraud training program purposes, anti-fraud tool improvement and manual detection procedures improvement.
- Completion of the Quarterly Fraud Report: savings amount, investigation status
- Contribute to our continuous enrichment of the Fraud KPIs list.
- Be an active contributor of the Fraud Operational Committees.
- Act as an anti-fraud expert within the company, supporting peers to continuously improve maturity level.
Benefits
- Generous Employer contribution for health, dental, and vision insurance
- Paid Maternity and Paternity Leave
- Scholarship Program for Employee Dependents
- Company match on 401k
- Employee Assistance Program (EAP)
- Company paid short-term and long-term disability insurance
- Company paid life insurance
- Voluntary Pet Insurance
- Voluntary Legal Benefit
- Discounts on travel insurance
- Time off policies including vacation days, sick days, personal days, holidays and volunteer days (VTO)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
