Overview:
Scroll down for a complete overview of what this job will require Are you the right candidate for this opportunity Conducts investigations to effectively pursue the prevention, investigation and prosecution of insurance fraud and abuse; to recover lost funds; and to comply with state regulations mandating fraud plans and practices.
Job Duties:
Conducts investigations of known or suspected acts of fraud and abuse.
Communicates with federal, state, and local law enforcement agencies as appropriate in matters pertaining to fraud cases.
Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, customer members, etc.
Facilitates the recovery of the company and customer money lost because of fraud matters.
Delivers educational programs designed to promote deterrence and detection of fraud and minimize losses to the company.
Maintains open communication with constituents within and external to the company.
Uses available resources and technology in developing evidence, supporting allegations of fraud and abuse.
Researches and prepares cases for clinical and legal review.
Documents all appropriate case activity in tracking system.
Cost effectively manages use of outside resources and vendors to perform activities necessary for investigations.
Required Qualifications:
Strong background in insurance fraud investigations.
Strong analytical and research skills.
Proficient in researching information and identifying information resources.
Strong verbal and written communication skills.
Consistent demonstration of accuracy, thoroughness and timeliness in completing work assignments; detail oriented.5 + years' SIU experience with an insurance carrier is required.
Strong customer service skills.
Ability to multitask at a high level.
Computer savvy with proficiency in Word, Excel, MS Outlook products, Database search tools, and use in the Intranet/Internet to research information.
Ability to utilize company systems to obtain relevant electronic documentation.
Preferred Qualifications:- Ability to communicate in English and Spanish.
- Claims handling experience.
- Strong background in Bodily Injury claims investigations.3+ years of experience in Investigations with a Law Enforcement Agency. xevrcyc
- EducationCollege degree in Criminal Justice or a related field, or a minimum of 8 years in law enforcement or insurance.
