Manager Special Investigation Unit
Manager Special Investigation Unit
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Job Description
JOB SUMMARY
This is an exempt position that reports to the Director Investigation and Recovery. The person in this position provides administrative investigative and educational services to all WCF departments policyholders state law enforcement agencies and other partners.
QUALIFICATIONS
- Bachelors degree in a relevant field or equivalent work experience; masters degree preferred.
- At least seven years experience in workers compensation insurance and property and casualty insurance fraud investigation law enforcement or criminal investigation.
- Certification as a Certified Fraud Examiner (CFE) or Certified Insurance Fraud Investigator (CIFI) preferred.
- Strong knowledge of insurance industry practices standards and terminology.
- Advanced proficiency in investigative interview techniques.
- Excellent organizational decisionmaking and analytical abilities.
- Proven leadership skills with a focus on team management interpersonal relations and customer service.
ESSENTIAL JOB FUNCTIONS
- Develop and implement investigation strategy to align with and support the corporate vision and objectives.
- Lead investigations into all types of workers compensation and commercial insurance fraud including application audit claimant policyholder producer underwriting premium and provider fraud.
- Manage a team of investigators and administrative staff ensuring proper resource allocation in line with the department and company strategy.
- Oversee the maintenance and continuous improvement of core systems including data dashboards to optimize operations.
- Ensure prompt and effective resolution of investigation requests from internal and external stakeholders.
- Manage the selection evaluation and oversight of vendors including private investigators and forensic experts.
- Establish and maintain a comprehensive system of policies procedures and workflows.
- Collaborate with law enforcement agencies criminal prosecutors and government bodies to ensure thorough and coordinated investigations.
- Utilize data and advanced technology to improve fraud detection and resolution processes.
- Review and prioritize fraud referrals based on their merit and validity.
ACCOUNTABILITY & REQUIREMENTS
- Prepare and submit annual compliance reports while ensuring ongoing training for all internal antifraud personnel.
- Maintain adherence to state regulatory requirements.
- Participate in investigation training sessions and meetings sharing knowledge gained with company personnel
VALUES
The individual in this role must exemplify the core values of WCF including a commitment to doing the right thing excelling at their job and helping others succeed to uphold the companys mission of excellence.
WORKING CONDITIONS
This role is based in an office environment with controlled temperature and lighting. While there are no significant hazardous conditions the position may involve highstress situations requiring adherence to tight deadlines.
Required Experience:
Manager
Employment Type
Full-Time
