Director Complex Claims
| Company | Sedgwick Claims Management Services |
|---|---|
| Location | Texas, USA, Wisconsin, USA, Ohio, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Senior, Expert or higher |
Requirements
- Bachelor’s degree from an accredited college or university preferred.
- Fraud Claims Law Associate (FCLA), Certified Insurance Fraud Investigator (CIFI), or Certified Fraud Examiner (CFE) strong preferred, or equivalent relevant certification.
- Ten (10) years of related experience in fraud detection, investigation, management, and compliance to include three (3) to five (5) years of supervisory experience handling complex fraud investigations, or equivalent combination of education and experience required.
- Strong knowledge of major case and/or fraud ring investigations
- Knowledge of fraud detection & investigation techniques, software and databases
- Strong knowledge of laws related to fraud, abuse, investigation, and state insurance reporting
- Expert witness, deposition, and trial testimony skills
- Lines of business expertise
- Leadership/management/motivational skills
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal skills
- Excellent negotiation skills
- Excellent oral and written communication skills
- PC literate, including Microsoft Office products
- Ability to work in a team environment
- Ability to meet or exceed Service Expectations
Responsibilities
- Analyzes complex fraud schemes involving providers, vendors, attorneys and others, to proactively develop responsive strategies in liaison with senior leaders and other key stakeholders.
- Proactively and strategically manages a complex fraud investigation case inventory by assessing actions of the team and providing guidance as necessary.
- Strategically partners with law enforcement, departments of insurance, legal counsel, and internal stakeholders for fraud related matters.
- Mentors and provides guidance to the SIU complex fraud team, analyst and compliance teams.
- Initiates and directs SIU compliance activities including carrier audits, state fraud reporting and internal management reporting.
- Establishes policy and procedure to assure compliance to SIU best practices and state regulations to meet carrier and client service requirements and to benefit our corporate stakeholders.
- Utilizes reporting to develop metrics and manage team performance.
- Meets with the team to roundtable issues within their caseloads.
- Provides individual coaching and development and small group training as needed.
- Meets with leadership to review issues, trends, and recommendations to further influence and create a culture of continual quality improvement.
Preferred Qualifications
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No preferred qualifications provided.