Claims Internal Fraud Specialist
1 day ago
**Responsibilities**:
- Directs and monitors progress on assigned multiple concurrent investigations.
- Ensures all investigative work, which may include work completed by others, is complete, accurate, professional, legally supported, and fully documented.
- Prepares detailed reports for presentation to company management and to law enforcement entities when fraudulent activity is identified.
- Participates in and may take a lead role monitoring the Proactive Detection Tools. Identifies high risk areas to be monitored.
- Ensures quarterly data reviews addressing fraud risk areas.
- Evaluates results and prepares quarterly reports for LMI Management.
- Notifies management of any control weaknesses identified and offers solutions to mitigate the risks.
- Assists in triaging investigative requests. Uses all available sources to determine the validity of any allegations received.
- Assists with special requests received by senior or executive management.
- Coordinates the collection of data for law enforcement and internal management requests.
- Leads complex continuous improvement efforts by providing feedback on investigative process and tool changes that will result in a better product being delivered.
- Participates in developing or enhancing fraud awareness and training programs.
**Qualifications**:
- Bachelor's Degree in a Business or Criminal Justice field, or equivalent training, is required.
- 3- 5 years related work experience in an investigation capacity required.
- Related claims handling experience is preferred.
- Interview and interrogation skills required.
- Excellent written and oral communication skills required.
- Ability to perform in an automated audit environment.
- Certified Fraud Examiner designation is preferred.
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