Major Case Investigator

Travelers Insurance
Tampa, Florida
Not Specified
Jul 10, 2019
Aug 31, 2019
Company Information
Solid reputation, passionate people and endless opportunities. That's Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference.

Job Summary
Responsible for analyzing data to determine fraud schemes, trends and conducting major case investigations concerning medical and non-medical systemic and organized fraud investigations in all lines of business, including: Auto, Property, General Liability and Workers Compensation. Provides investigative expertise to detect fraud, limit exposure and protect company assets. Focus is directed towards multiple complex case investigations with regional and national implications. This job does not manage others This job works under General Direction: Establishes procedures for attaining specific goals and objectives in a broad area of work. Generally final results are reviewed. (Typically applies to a manager or expert/top level professional.)

Primary Job Duties & Responsibilities
ESSENTIAL FUNCTIONS Analyzes and summarizes highly technical information related to multiple complex case investigations with regional and national implications. Makes key decisions regarding the structuring and conduction of major case investigations involving multiple claims and/or organized fraud ring activity with regional and national impact. Proactively uses analytical skills to identify potential areas of organized fraud activity or identify areas of vulnerability to fraud to develop investigative plans and/or solutions. (Assists in forecasting needs from emerging trends in the major case and/or organized fraud arena in local area. (e.g., National Insurance Crime Bureau (NICB) and industry alerts, leads from lines of business, etc.). Conducts thorough insurance field investigations while managing resources with a focus on uncovering all potentially fraudulent aspects of claims. Conducts technical training for investigative staff to build knowledge base in major case and/or fraud ring identification and investigative techniques. Applies the techniques of critical thinking to prioritizes and develop investigations that have complex allegations and/or significantly financial impact to multiple claims and/or organized ring activity spanning across multiple lines of business and potentially across several states. Applies Local, State and Federal statutes to ensure investigations are carried out within the requirements of applicable law and local office expectations. Provides exceptional customer service by maintaining contact with business partners, customers and external resources throughout the life of each investigation. Acts as a liaison with local/state/federal law enforcement personnel, industry advocates and other companies. Serves as the subject matter expert (liaison) on fraud (medical and non-medical) to business and industry partners. Applies rules of evidence; recognizes evidence and determines its value to specific claim, evidence collection and interpretation. Establishes and maintains liaison network with public officials, law enforcement officers and others to obtain assistance in conducting investigations. Identifies cases for potential insurance fraud prosecution and submits questionable claims to the National Insurance Crime Bureau. Reviews, understands and applies all applicable statutes: local, state and federal to ensure duties and assignments are carried out within the requirements of applicable law and local office expectations. Identifies and addresses investigative priorities through strategic partnerships. Prepares and conducts technical training in detecting and applying techniques to multiple complex cases. Testifies to findings. May conduct missed opportunity reviews of claim files as needed (e.g., by line of business, by emerging trends, etc.). Perform other duties as assigned.

Minimum Qualifications
A minimum of five years of investigative experience; or a minimum of five years insurance claim related experience required. Valid driver's license required.

Education, Work Experience & Knowledge
Bachelor's Level Degree

Job Specific & Technical Skills & Competencies
PREFERRED JOB SPECIFIC TECHNICAL SKILLS AND COMPETENCIES Analytical skills and ability to make deductions; logical and sequential thinker. - Advanced Analytical and problem solving skills to use and interpret information and facts as well as apply critical techniques to investigative process - Advanced Effective business communication skills (Written & Verbal) - Advanced Computer literate; database, Internet and social media proficient - Advanced Interviewing skills - Advanced Computer literate; database and internet emerging social media use/search proficiency. - Advanced Conflict management skills to deal with crisis situations, hostile witnesses, etc. -Advanced Must be a self-motivated individual - Intermediate Excels at working independently, while making decisions to successfully pursue medical and non-medical insurance fraud through establishing significant facts while preserving material that leads to the resolution of the investigation. - Intermediate Knowledge of available resources (internal and external) to assist in investigations- Advance Working level knowledge of insurance and claim operations, Commercial Lines, Personal Lines, and Workers Compensation insurance products. - Intermediate Time management and accurate record keeping - Intermediate Effective business communication skills (Written & Verbal) - Advanced -Strong case management skills and the ability to manage your own work independently. - Intermediate Adapt to changes in process and shifting priorities - Intermediate Must take ownership/initiative; significant planning and goal setting skills required - Intermediate Presentation and training skills. Intermediate Understanding of claim best practices - Intermediate Leadership, including delegation and ability to get work done through others- Intermediate Influence and conflict management skills - Intermediate

Environmental/Work Schedules/Other
Work Schedules Overnight work hours: Occasionally. Other Travel: Frequently. Incumbents who fill this position will be subject to periodic post-hire criminal background checks while employed in this position. As a condition of acceptance for the position, selected candidates for this position will be required to electronically accept the Fair Credit Reporting Act (FCRA) Disclosure Statement and Authorization included in the online employment application. You may also be subsequently asked to accept similar FCRA authorizations periodically throughout your employment with the Company.

Physical Requirements
Operates standard office equipment: Frequently. Sitting (can stand at will): Continuously. Standing: Occasionally. Lifting items up to 20 pounds: Occasionally. Use of Keyboards, Sporadic 10-Key: Frequently. Driving: Frequently.

Equal Employment Opportunity Statement
Travelers is an equal opportunity employer.
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