Claims Investigator

2 days ago


Vaughan, Ontario, Canada CAA Club Group Full time

Job Summary

We are seeking a highly skilled Claims Investigator to join our Special Investigations Unit (SIU) team at CAA Club Group. As a Claims Investigator, you will play a critical role in evaluating concerns and fraud indicators to develop investigative plans for all lines of business in insurance claims.

Key Responsibilities

  • Evaluate concerns and fraud indicators to develop investigative plans for all lines of business in insurance claims, including Property, Auto Fire and Theft, Casualty, Accident Benefits, and claims with Legal disputes.
  • Serve as a resource for the claims operation for special investigations and fraud.
  • Consult internally with Claims business units (all lines) and provide resources and recommendations to assist the fraud initiatives as required.
  • Communicate effectively with all stakeholders and prepare reports, trial briefs, and updates on investigations in a timely and respectful manner.
  • Build and maintain productive business relationships with law enforcement, government bodies, and investigative organizations.
  • Attend court proceedings or hearings as required.
  • Ensure ongoing handling of claims investigations within company standards and industry best practices and regulations.
  • Responsible for overall file handling and work product quality.
  • Comprehensive knowledge of SIU regulations.
  • Assist with ongoing training of all internal anti-fraud personnel.
  • Provide feedback to Management on process and system improvement initiatives for the department.
  • Comply with relevant provincial and federal laws, Insurance regulations, insurance carrier best practices, and follow and enforce CAA Claims policies, procedures, and best practices.
  • Assist with evaluating, selecting, and ensuring quality and cost containment for vendors, including defense firms, private investigators, records review companies, legal document and photocopy companies, expert witnesses, and any other vendors that might be used for the settlement of relevant auto claims.

Requirements

  • Post-secondary education in Criminology, Insurance Management, Business Administration, or a related field.
  • CIP designation completed or in progress is preferred.
  • Strong passion for the P&C insurance industry with a focus on fraud containment.
  • Strong technical, analytical, and problem-solving skills and the ability to exercise prudent judgment to make decisions based on accurate and timely analysis of trends.
  • Ability to work in teams and independently as required.
  • 5+ years' experience in the Property and Casualty insurance industry.
  • 2+ years as an SIU investigator.
  • Litigation experience and legal knowledge.
  • Clear understanding of insurance industry practices, standards, and terminology.
  • Some experience handling property damage and injury claims, as well as serious injuries and litigation.
  • Valid driver's license and personal vehicle.

What We Offer

  • Competitive salary.
  • Annual bonuses and merit increases.
  • 3 weeks' vacation.
  • Flexible benefit plan.
  • Defined Contribution Pension.
  • Complimentary CAA Membership.

As an organization, we are focused on Member safety, which includes the safety and well-being of our Associates. Therefore, you must be and remain fully vaccinated as a condition of employment.


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