SIU Investigator – Underwriting & Premium Fraud

Placentia, CA - USA

Yearly Salary: $ 54000 - 103000

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

You have a clear vision of where your career can go. And we have the leadership to help you get there.At CNA we strive to create a culture in which people know they matter and are part of something important ensuring the abilities of all employees are used to their fullest potential.

Under minimal direction initiates and manages suspected fraudulent underwriting and insurance premium investigations involving the highest complexity matters. Provides advice direction and support to underwriters auditors business unit leadership corporate investigations and other stakeholders across the organization on the detection investigation and litigation of suspected underwriting matters.

JOB DESCRIPTION:

Essential Duties & Responsibilities

Performs a combination of duties in accordance with departmental guidelines:

Leads the detailed analysis and completion of thorough and timely investigations of suspected underwriting fraud by following Best Practice Guidelines and collaborating with business stakeholders.
Develops and executes investigation strategy either independently or in collaboration with underwriting professionals counsel experts insureds and other stakeholders.
Manages investigation activities independently and/or coordinates/oversees vendor service partner activities in the field.
Maintains detailed accurate and timely case records by following established Best Practices for file documentation and by creating comprehensive reports of investigative findings and conclusions.
Makes recommendations for resolution by presenting evidence-based findings and proposing solutions of moderate to complex scope.
Identifies opportunities and participates in the design and implementation of process or procedural improvements.
Leads or directs efforts to build and enhance and oversees organizational capabilities by developing and delivering fraud awareness or regulatory compliance training and mentoring SIU staff.
Leads or directs the preparation of cases for appropriate reporting to outside agencies; leads or directs pursuit of criminal or civil actions through gathering and documenting relevant data organizing and summarizing facts and testifying on behalf of the company in civil or criminal matters.
Continuously develops knowledge and expertise related to insurance fraud by keeping current on related law regulations trends and emerging issues and participating in insurance fraud or related professional associations.

May perform additional duties as assigned.

Reporting Relationship
Typically Manager or Director

Skills Knowledge and Abilities

Solid knowledge of property and casualty claim handling practices
Strong technical knowledge of practices and techniques related to investigations and fact finding. For roles focused in an area of specialty (medical provider investigations) strong technical knowledge of respective specialty practices is required.
Strong interpersonal oral and written communication skills; ability to clearly communicate complex issues
Ability to interact and collaborate with internal and external business partners including outside agencies
Ability to work independently exercise good judgment and make sound business decisions
Detail oriented with strong organization and time management skills
Strong ability to analyze complex ambiguous matters and develop effective solutions
Proficiency with Microsoft Office applications and similar business software and understanding of relational databases information querying techniques
Ability to adapt to change and value diverse opinions and ideas
Developing ability to implement change
Ability to travel occasionally (less than 10%)

Education and Experience

Bachelors degree or equivalent professional experience.
Minimum of three to five years of experience conducting investigations in the area of a) insurance fraud b) law enforcement c) civil or criminal litigation or d) similar field.
Professional certification or designation related to fraud investigations strongly preferred (e.g. CFE CIFI FCLS FCLA or similar).

#LI-AR1

#LI-Hybrid

In certain jurisdictions CNA is legally required to include a reasonable estimate of the compensation for this District of Columbia California Colorado Connecticut Illinois Maryland Massachusetts New York and Washington the national base pay range for this job level is $54000 to $103000 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 CNAs benefits please visit.

CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation please contact.

JOB DESCRIPTION:

Essential Duties & Responsibilities

Performs a combination of duties in accordance with departmental guidelines:

Leads the detailed analysis and completion of thorough and timely investigations of suspected underwriting fraud by following Best Practice Guidelines and collaborating with business stakeholders.
Develops and executes investigation strategy either independently or in collaboration with underwriting professionals counsel experts insureds and other stakeholders.
Manages investigation activities independently and/or coordinates/oversees vendor service partner activities in the field.
Maintains detailed accurate and timely case records by following established Best Practices for file documentation and by creating comprehensive reports of investigative findings and conclusions.
Makes recommendations for resolution by presenting evidence-based findings and proposing solutions of moderate to complex scope.
Identifies opportunities and participates in the design and implementation of process or procedural improvements.
Leads or directs efforts to build and enhance and oversees organizational capabilities by developing and delivering fraud awareness or regulatory compliance training and mentoring SIU staff.
Leads or directs the preparation of cases for appropriate reporting to outside agencies; leads or directs pursuit of criminal or civil actions through gathering and documenting relevant data organizing and summarizing facts and testifying on behalf of the company in civil or criminal matters.
Continuously develops knowledge and expertise related to insurance fraud by keeping current on related law regulations trends and emerging issues and participating in insurance fraud or related professional associations.

May perform additional duties as assigned.

Reporting Relationship
Typically Manager or Director

Skills Knowledge and Abilities

Solid knowledge of property and casualty claim handling practices
Strong technical knowledge of practices and techniques related to investigations and fact finding. For roles focused in an area of specialty (medical provider investigations) strong technical knowledge of respective specialty practices is required.
Strong interpersonal oral and written communication skills; ability to clearly communicate complex issues
Ability to interact and collaborate with internal and external business partners including outside agencies
Ability to work independently exercise good judgment and make sound business decisions
Detail oriented with strong organization and time management skills
Strong ability to analyze complex ambiguous matters and develop effective solutions
Proficiency with Microsoft Office applications and similar business software and understanding of relational databases information querying techniques
Ability to adapt to change and value diverse opinions and ideas
Developing ability to implement change
Ability to travel occasionally (less than 10%)

Education and Experience

Bachelors degree or equivalent professional experience.
Minimum of three to five years of experience conducting investigations in the area of a) insurance fraud b) law enforcement c) civil or criminal litigation or d) similar field.
Professional certification or designation related to fraud investigations strongly preferred (e.g. CFE CIFI FCLS FCLA or similar).

#LI-AR1

#LI-Hybrid

CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation please contact.

Key Skills

Risk Management
Bank Secrecy Act
Fraud
PCI
Law Enforcement
Banking
Business Management
Regulatory Reporting
Analysis Skills
Customer Support
UCC Law
RMF

Apply Now

About Company

CNA

CNA provides insurance solutions to more than 1 million businesses and professionals worldwide. With more than 100 years of industry experience, CNA has earned a reputation as one of the most trusted commercial insurance companies in the business. We’re a powerful legacy built on expe ... View more

View Profile View Profile

AI AutoApply

Apply to 100+ jobs with one click