Claims Investigator

Claims Investigator

Requirements

• Strong expertise in suspect claim identification and handling
• Experience with using data analytics to identify fraudulent activity
• High level of acumen in the areas of investigation, listening, strategic/analytical thinking, problem solving, and innovative thinking
• Strong knowledge of general industry trends and legislative activities in regard to fraudulent claim handling, tort reform, fraud statutes, and civil/criminal procedures
• Clear interest in and quality execution of ‘deeper’ level investigations
• Strong interpersonal/relationship skills
• Highly proficient collaboration expertise
• Excellent verbal and written communication skills
• Ability and desire to work with confidence, autonomy, initiative, and ambition
• High level of dependability, accountability, and integrity
• Travel required

Responsibilities

• Analyze data, first notice of loss and accompanying file material to determine if a claim is suspect or potentially fraudulent
• Conduct a complete, in-depth investigation to develop sufficient evidence to determine the claim handling decision
• Recommend a final course of claim action- substantiation of legitimate claim, or denial of an unjustified claim, and/or a recommendation of further punitive action to successfully execute the above
• Collaborating and communicating with the following during the investigation: Claim Department, Avis Operations, Counsel, Law Enforcement, Regulatory Agencies, and Industry Anti-Fraud Organizations
• Developing and maintaining excellent relationships with all of the above
• Ensuring strong customer service and relations at all times
• Managing (selecting, directing, employing, and maintaining) private investigator panel of independent contractors and other vendors for quality and cost effective results
• Maintaining and monitoring an active diary, properly documenting all developments in claim file, preparing investigative reports, maintaining suspicious claim database, and preparing reports on a quarterly basis to supervisors
• Being familiar with and appropriately adhering to fraud statutes
• Actively pursuing memberships in professional anti-fraud investigative organizations and participating in associated training and events offered
• Training and influencing internal partners and our TPA to detect and prevent insurance fraud
• Adhering to statutory regulations, and Unfair Claims Practice Acts
• Ensuring the character and reputation of our company, renters and/or drivers are positively maintained- not maligned or criticized as well as ensuring that investigations have a clear, single focused intent of uncovering and providing necessary facts to expeditiously resolve a claim in a quality manner

Preferred Qualifications

• College degree preferred
• Law enforcement experience a plus
• Prior Casualty SIU investigation experience or Casualty claims background a plus