Specialist, Claims Investigation
About The Position
In this role, you will be tasked with proactively identifying red flags as well as supporting referrals for SIU engagement. You will provide claims investigative support and information to assigned claims area(s), Corporate Compliance, and Legal. You will attend claims consults/huddles, review, report on, and audit open inventory items and referrals, and address questions from internal/external stakeholders. You will assist management with prioritizing work, developing team initiatives, contributing to training, as well as providing support in the manager’s absence.
Requirements
- 4 Year/bachelor's degree or equivalent work experience (4 years of experience in lieu of Bachelor's) (Minimum Required)
- An associate or bachelor’s degree in criminal justice or a related field; or
- 5+ Years experience in claims investigation experience or professional investigation experience with law enforcement agencies; or
- 7+ years of professional investigation experience involving economic or insurance related matters
Nice To Haves
- Investigative background such as law enforcement or private investigator.
Responsibilities
- Maintain knowledge on current and emerging developments/trends related to insurance fraud.
- Complete assigned proactive reviews weekly to support the claims operation in identifying potential fraud and opportunities for SIU resource utilization.
- Review assigned surveillance and field investigator referrals from claims team to ensure investigative resources are used appropriately; periodically review database referrals and output.
- Complete assigned quality audits per referral type (field investigation, database, surveillance) per vendor each month.
- File Suspicious Incident Reports in accordance with state requirements, address questions and requests for documentation from state departments of insurance; send to Corporate Compliance files in which activity meets the definition of fraud.
- Deliver New Hire and ad hoc training on various topics such as ISO, social media/database research, and system(s) used.
- Stay informed on state and federal regulations and guidelines and perform duties in compliance with all state and federal regulations and guidelines.
- Remain current in profession and industry trends.
Benefits
- PTO/parental leave
- Competitive 401K and employee benefits
- Free financial counseling, health coaching and employee assistance program
- Tuition assistance program
- Work arrangements that work for you
- Effective productivity/technology tools and training
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
1,001-5,000 employees
