| Fraud Investigation || San Antonio, TX (Onsite) at San Antonio, Texas, USA |
| Email: [email protected] |
| Job Title: - Fraud Investigation Client location San Antonio, TX (Onsite) Interview Mode: Video Role Description: As a Process Expert in Fraud Investigation, you will handle a wide variety of fraud-related investigations across four main areas: Claims Investigation/Life Annuity Investigation, Financial Crime/Fraud, Medicare Supplement Claims, and Life Company Product Fraud. You will be responsible for completing regulatory reporting, developing fraud strategies, and managing operational fraud losses within the approved risk appetite. Your role includes fraud detection, preparing comprehensive reports, and participating in risk assessments and audits related to fraud in life insurance companies. Key Responsibilities: Fraud Investigations: Conduct in-depth investigations covering Claims Investigation, Financial Crime, Medicare Supplement Claims, and Product Fraud. Regulatory Reporting: Ensure all regulatory reporting requirements are met and completed efficiently. Fraud Trends & Strategies: Develop, maintain, and monitor fraud trends and strategies within life insurance companies. Operational Fraud Loss Management: Manage and control operational fraud losses within the organization's risk tolerance. Investigative Reports: Prepare and present detailed investigative reports, summarizing findings and recommendations. Fraud Detection & Recovery: Lead investigation, resolution, and recovery activities related to fraud cases. Risk Assessments & Audits: Participate in internal fraud-related risk assessments and audits of life insurance companies. Professional Writing: Draft contestable claims letters to be reviewed by the Business Process Owner (BPO) or a Senior Investigator until proficiency is achieved. Validation Process: Ensure accuracy and completeness of investigations throughout the case lifecycle, including activation, closure, and documentation of findings. Competencies: Claims Processing (Life and Pensions) Knowledge of Life Insurance Ecosystem Required Experience: 6-8 years of experience in fraud investigation or claims processing. Essential Skills: Minimum of 2 years claims adjusting experience or SIU/Fraud Investigation experience, OR 4 years of prior investigative law enforcement experience (including military) or relevant fraud investigation experience. Proven investigatory skills and experience in acquiring statements from various parties, witnesses, and suspects. Strong ability to gather evidence and assess fraud applicability based on objective details. Ability to manage multiple tasks, prioritize workload, and devise problem-solving strategies. Proficiency in using computers and software packages to extract and analyze data from various sources. Knowledge of regulations, legal concepts, contracts, case law, medical treatment, and terminology. Desirable Skills: Certified Fraud Examiner (CFE) or prior Special Investigations Unit (SIU) experience. Law enforcement background. Familiarity with regulatory frameworks, city, state, and local fraud-related regulations. Understanding of medical treatment processes and terminology. Feel free to let me know if you have any questions. -- Keywords: information technology California Texas Fraud Investigation || San Antonio, TX (Onsite) [email protected] |
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| Wed Oct 09 01:45:00 UTC 2024 |