Officer position responsible for providing direction and management for both an internal investigations group and external providers of fraud investigation services. Directs the development and implementation of strategic and operational objectives for internal and external claim fraud management, in accordance with the company’s strategic plans.
Essential Duties & Responsibilities
- Performs a combination of duties in accordance with departmental guidelines:
- Implements strategic and operational objectives with substantial impact on the short-term success of the SIU operations.
- Leads, directs and has full management accountability for staff in area of responsibility with an emphasis on talent management and succession planning in accordance with corporate strategic direction.
- Ensures the successful application and execution of investigations policies, guidelines, insurance laws and regulations by subordinate staff and external service providers.
- Participates in the development and implementation of investigations policies, predictive modeling tools and business strategies that proactively mitigate company’s financial exposure.
- Provides oversight and guidance for the monitoring and evaluating of applicable activities of service provider operations ensuring services are performed in accordance with corporate policy, strategic direction and contract provisions, and recommends corrective actions where applicable.
- Partners with various business leaders to ensure knowledge sharing on trend analysis, pertinent and relevant business analytics/intelligence in order to enhance education, collaborate on strategic initiatives, identify potential business threats, improve customer service and appropriately align resources.
- Monitors state/territory regulations and issues, industry activity and trends. Represents the company, as a subject-matter-expert at industry trade groups and conferences. Ensures CNA's compliance with state fraud and regulatory reporting requirements nationwide.
May perform additional duties as assigned.
Typically VP and above
Skills, Knowledge & Abilities
- In-depth technical knowledge of theories and practices within claimsinvestigation and working knowledge in other related fields.
- Ability to effectively interact and communicate with all levels of external and/or internal business partners within scope of responsibility, team and/or matrix environment
- Leadership and management skills demonstrating integrity and professionalism.
- Extensive analytics skills with knowledge of SIU specific metrics to drive fraud mitigation and avoidance strategies and corresponding reporting.
- Ability to drive results by identifying, and resolving problems within scope of responsibility.
- Knowledge of the insurance industry, its products and services.
- Experience implementing, integrating and using predictive fraud models
- Knowledge of Microsoft Office Suite and other business-related software.
Education & Experience
- Bachelor’s degree with Master’s preferred in finance, business or related field or equivalent.
- Typically a minimum of 10 years claims SIU experience, with five years SIU management experience.
- Applicable certifications preferred.