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Professional Claims Investigator for Insurance Fraud Prevention
2 months ago
As a Professional Claims Investigator for Insurance Fraud Prevention at CAA Club Group, you will play a critical role in evaluating concerns and fraud indicators to develop investigative plans for all lines of business in insurance claims. You will serve as a resource for the claims operation for special investigations and fraud.
Key Responsibilities:
• Evaluate concerns and fraud indicators to develop investigative plans for all lines of business in insurance claims
• 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 (police, fire, and border control), 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
Requirements
• Post-secondary education in Criminology, Insurance Management, Business Administration or related field
• 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
• 5 plus years' experience in the Property and Casualty insurance industry
• 2 plus years as an SIU investigator
• Litigation experience and legal knowledge
• Must have a clear understanding of insurance industry practices, standards and terminology;
• Some experience handling property damage and injury claims as well as serious injuries and litigation
• Bilingual proficiency in both French and English (verbal and written)
What We Offer
• Competitive total compensation and benefits package ($85,000 - $110,000 per year)
• Annual shared success program based on performance
• Annual merit increases based on performance
• Registered Retirement Savings Plan with a matching contribution component
• Complimentary CAA Membership
