Leads and directs activities of internal special investigations unit and SIU vendor service providers. Accountable for managing and driving business results through oversight of teams responsible for suspected fraud. In conjunction with senior management, works within the limits of authority on matters requiring a high degree of technical knowledge and expertise. Has line of business, regional, industry segment, or company-wide scope of responsibility.

JOB DESCRIPTION:

Essential Duties & Responsibilities
Performs a combination of duties in accordance with departmental guidelines:
Leads the overall operational activities, budgetary, and financial responsibilities of fraud investigations unit by directing the services provided by both internal resources and external service providers to maximize unit performance.
Participates in the development and execution of strategic and operational initiatives based on departmental and corporate goals and objectives.
Ensures vendor services are performed in accordance with corporate policy, contract provisions, fiduciary guidelines, and service agreements by participating in the negotiations, monitoring, and evaluating vendor performance.
Makes informed strategic and operational business decisions by identifying and analyzing trends and improvement opportunities through the effective use of resources, tools, and metrics.
Responsible for the ongoing management of staff by attracting talent, setting clear direction, providing appropriate guidance, managing performance, recognizing contributions, and developing capabilities.
Maintains transparent communication by appropriately communicating organization information through department meetings, one-on-one meetings, email and regular interpersonal communication; works to build consensus.
Ensures quality by establishing and overseeing best practices, and ensuring the development and delivery of training as needed.
Maintains and shares industry knowledge by keeping current on law, trends, and issues.
Represents the company at industry associations and representing the company at insurance fraud or related industry associations and events.
May participate in special projects including investigations or surveillance on high complexity matters.

Skills, Knowledge and Abilities

1. Ability to effectively lead, coach and develop an investigations group consisting of multiple layers, and effectively manage external service providers.
2. Technical and business management acumen; advanced claims investigations and resolution skills; advanced knowledge of insurance and claims handling principles, practices, and procedures.

3. Technical and business management acumen; advanced underwriting investigation and risk assessment skills; advanced knowledge of underwriting principles, practices, procedures, and insurance operations.

4. Excellent communication, negotiation, and presentation skills with the ability to effectively interact with internal and external business partners at all levels.
5. Excellent analytical and problem solving skills, with the ability to simultaneously manage multiple projects and teams.
6. Ability to deal effectively with ambiguous situations and issues.
7. Creative thinker; embraces diverse and innovative ideas to solve problems.
8. Proven ability to achieve results by taking a proactive long-term view of business goals and objectives.
9. Proficiency with Microsoft Office Suite and business software.
10. Acts with a sense of urgency to advance priorities of the organization.
11. Helps others to excel through collaboration and building strong relationships.
12. Raises expectations of self and others by continuously learning and broadening industry and technical skills.

Education and Experience
1. Bachelor's degree or equivalent professional experience; advanced degree highly desired.

2. Professional certification or designation related to fraud investigations strongly preferred (e.g., CFE, CIFI, FCLS, FCLA, or similar).

3. Minimum of ten (10) years of experience conducting or directing investigations in the area of a) insurance fraud, b) law enforcement, c) civil or criminal litigation, or d) similar field.

4. Experience managing or supervising others preferred.

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In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $97,000 to $189,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com.

CNA utilizes AI-enabled technology during the recruiting process. For more information, please visit our careers page.