Pittsburgh, PA
(Click company name to view employer profile and all available positions.)
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| Career Field |
Claims, Loss Control/Risk Management
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| Insurance Discipline |
All
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| Relocation Assistance |
Not Available
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| Job Duration |
Full Time |
| Salary Offered |
Open
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SUMMARY:
Conduct investigations to detect fraud on claims against the company. Provide investigative expertise to limit exposure and protect company assets. These investigations involve all lines of insurance. Position may include lead investigator functions as described below.
PRIMARY DUTIES:
Conducts investigations with a focus on thoroughness, quality, with attention to detail, timeliness and cost control.
Prepares and submits investigative reports covering all phases of the investigation in each case for approval.
Assists with the development and training of the claim staff in the detection of external and or internal fraud, plus workplace violence.
Interprets and conveys highly technical information to others.
Applies rules of evidence; recognizes evidence and determines its value to specific claim, evidence collection and interpretation. Requires clear understanding of the rules of evidence.
Establishes and maintains liaison with public officials, law enforcement officers and others to obtain assistance in conducting investigations.
Knowledgeable about all applicable fraud statutes: local, state and federal to ensure duties and assignments are carried out within the requirements of applicable law and local office expectations.
High degree of integrity and confidentiality required handling information that is considered personal and confidential.
Customer Service and relationship/team building by maintaining contact during the course of investigations with company''s claim services, Marketing and Underwriting colleagues, claimants, policyholders, agents, counterparts in other firms, external legal professionals, external medical professionals, financial institutions, government/regulatory agencies, potential customers and vendors and suppliers.
Develops network of resources within the community (e.g., local fraud bureaus, district attorneys offices, law enforcement agencies, insurance associations, professional associations, and community groups).
Requires overnight travel.
Works in a position where frequent exposure to noise, dirt, odors or where work may be performed in a confined or restricted area.
An investigator can function as lead role by performing all of the following duties in addition to those described above:
Lead investigator, responsible for guiding and training other investigators in the performance of their duties.
Serves as subject matter expert in two or more specialty areas (e.g., major case, medical fraud, construction losses. etc.).
Runs special projects or initiatives at local and regional level with planning and implementation responsibilities and accountability for outcome.
Serves as assistant and regular backup for Regional Manager.
May close cases, assign work, direct activities of investigators as ''lead'' with clear line of authority in Manager''s absence.
Represents SIU as a technical resource by attending unit meetings (e.g., auto, property, subrogation, marketing, underwriting, legal proceedings as needed at the local level and acts within established professional guidelines as well as applicable state laws
EDUCATION/COURSE OF STUDY:
Minimum 2-year college degree or equivalent law enforcement or claim experience.
WORK EXPERIENCE:
Working level knowledge of insurance and claim operations, commercial, personal, and Workers Compensation insurance products and litigation management.
Claim, legal or law enforcement background.
OTHER:
Interviewing skills.
Analytical skills and ability to make deductions; logical and sequential thinker
Computer literate; database and Internet proficient.
Knowledge of available resources (internal and external) to assist in investigations
Conflict management skills to deal with crisis situations, hostile witnesses, etc.
Additional lead investigator required qualifications, skills and competencies:
Delegation, organization and follow-up skills. Ability to get work done through others.
Working knowledge of budgets and other fiscal responsibilities.
Critical Success Factors:
Productivity (referral rate and average referrals per investigator)
Customer Service and Timeliness of Investigation (close rate and average duration of investigation)
Expense Management (return on investment and billing)
Quality of Investigation (efficiency rate and QA score)
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