Claims Siu Inside Investigator

**We're now at the boldest phase of our Next Horizon journey**

At Gore Mutual, we've completely transformed our business in under three years. By investing in top talent and leading technology, we've redefined what it means to be a modern mutual that does good.

Our path forward brings a sharper focus on our business' performance that's powered by innovation and an agile, high-performing culture - we're built for success.

**We're well on our way to becoming a purpose-driven, digitally led national insurer. Come join us.**

The Claims SIU - Inside Investigator role functions as a inside anti-fraud investigator and carries out investigations that do not require field work or where field work can be tasked out to SIU field investigators or vendors.

**What will you do?**
- Review files referred and compose and update investigation strategy through the life of the file.
- Investigate and/or use SIU vendors to determine if there is evidence of fraud by clients, third-party claimants, suppliers (e.g., body shops, medical treatment providers, etc.).
- Review submitted documents for inconsistencies/other signs of fraud.
- Identify patterns, quantify loss exposure, and develop mitigation action plans.
- Escalate significant fraud events such as data breaches and collusive activity and provide insights to senior leadership.
- Arrange and participate in examinations under oath where required.
- Compose final report and recommendation to the claims department for disposition of the file.
- Carry out investigative tasks such as obtaining official reports, recorded interviews, and other as required.
- Review and prioritize incoming SIU referrals by amount incurred, complexity, visibility, potential risk to Gore, limitation date, and other factors.
- Assign files within 48 hours to appropriate internal SIU handler for disposition.
- Assist in the design and delivery of regular, customized fraud awareness, detection, investigation, and avoidance training for various specialized lines of business including Underwriting, Claims, and Business Development.
- Ensure all investigations are carried out in a pro-active, professional manner with utmost good faith and that customer/broker enquiries are responded to in a timely way.
- Support inter-industry anti-fraud initiatives: Attend industry training as required, CASIU events, Equite committee meetings, and other events to maintain proficiency and ensure Gore is aware of the latest trends in insurance fraud.
- Assist in the review, implementation, and ongoing use of artificial intelligence tools Gore uses to assist with fraud detection. This includes validation of outputs, tracking of savings driven by the tool, and reporting on the same.

**What will you need to succeed?**
- Experience in conducting investigations related to fraud.
- Knowledge of anti-fraud practices and the ability to use various investigation techniques and resources.
- Strong analytical skills to identify patterns, quantify loss exposure, and develop mitigation plans.
- Excellent communication skills to prepare reports, conduct training, and interact with internal and external stakeholders.
- Ability to manage multiple tasks and prioritize incoming referrals.
- Familiarity with industry events, ongoing training, and use of artificial intelligence tools for fraud detection.
- Proficiency in maintaining databases and collaborating with internal partners to improve fraud detection processes.
- Commitment to maintaining professional relationships with industry partners and supporting inter-industry anti-fraud initiatives.

**Location**: We're a hybrid team that thrives on the energy and value of in-office collaboration. This role offers the best of both worlds, with 1-2 days a week spent in our vibrant office in Cambridge, Ontario

**#LI-Hybrid**

**#INDHP