Claims Investigation Manager
Claims Investigation Manager
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Job Description
Position Summary
The Claims Investigation Manager is responsible for managing the team of claims investigation professionals and overseeing the claims investigation process to ensure accuracy compliance and fraud prevention. The role develops and implements investigation strategies provides guidance and support in complex cases and collaborates cross functionally for claim investigation and resolution. They review evidence and documentation conduct interviews and site inspections analyze data to identify trends or irregularities and make recommendations for claim settlements or denials based on findings.What will your job entail
Job Responsibilities:
Manages the team of claims investigators ensures they are properly trained and equipped to handle investigations and sets team KPIs. Conducts performance evaluations provides feedback and implements performance improvement plans when necessary.
Ensures that all investigations are conducted in compliance with company policies industry regulations and legal requirements.
Develops and implements strategies to detect and prevent insurance fraud identifies suspicious claims and coordinates with relevant authorities for further investigation if necessary.
Analyzes trends and patterns in claims data to identify potential risks or areas of concern and recommends proactive measures to mitigate risks.
Partners with teams in claims processing legal and risk management to ensure seamless claim handling and resolution. Participates in the investigation of complex insurance claims assesses damages verifies facts and interviews involved parties to gather evidence.
Implements quality assurance measures to assess the accuracy and thoroughness of investigations and identifying areas for improvement. Leverages technology and software tools to streamline and improve the efficiency of claim investigation processes.
Oversees the documentation of investigation findings preparation of detailed reports and oversees the maintenance of claims and investigation activities.
Participates in budget planning and management of the team including resource allocation and expense control.
Work Experience and Education:
Bachelors degree in Legal Finance Business Administration or a related field with 6 years of related experience. Any other related discipline or commensurate work experience considered.
3 years of supervisor or lead experience.
Licenses & Certifications:
Certified Insurance Fraud Investigator (CIFR) Certified Fraud Examiner (CFR) Associate in Claims (AIC) or Professional Certified Investigator (PCI) is preferred.
Ryan Specialty is an Equal Opportunity Employer. We are committed to building and sustaining a diverse workforce throughout the vision is an inclusive and equitable workplace where all employees are valued for and evaluated on their performance and contributions. Differences in race creed color religious beliefs physical or mental capabilities gender identity or expressionsexual orientation and many other characteristics bring together varied perspectives and add value to the service we provide our clients trading partnersand policy extends to all aspects of our employment practices including but not limited to recruiting hiring discipline firing promoting transferring compensation benefits training leaves of absence and other terms conditions and benefits of employment.
How We Support Our Teammates
Ryan Specialty seeks to offer our employees a comprehensive and bestinclass benefits package that helps them and their family members achieve their physical financial and emotional wellbeing goals. In addition to paid time off for company holidays vacation sick and personal days Ryan offers paid parental leave mental health services and more.
The target salary range for this position is $94150.00 $100000.00 annually.The wage range for this role considers many factors such as training transferable skills work experience licensure and certification business needs and market demands. The pay range is subject to change and may be modified in the future. Fulltime roles are eligible for bonuses and benefits. For additional information on Ryan Specialty Total Rewards visit our website provide individuals with disabilities reasonable accommodations to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment in accordance with applicable law. Please contact us to request an accommodation at
The above is intended to describe this jobs general requirements. It is not to be construed as an exhaustive statement of duties responsibilities or physical requirements. Nothing in this job description restricts managements right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Required Experience:
Manager
Employment Type
Full-Time
