Anti-Fraud Manager

About the role

We’re a team of employees passionate about delivering best-in-class customer service and innovation in the industry. Integrity, relationships, and excellence are at the heart of everything we do. Our employees fully utilize their talents and bring their best selves to work. We believe who you are is just as important as what you do!

Key Responsibilities

• Supervises the day-to-day investigative activity of SIU field/desk investigations and support activities throughout regions.
• Acts as the direct liaison with the various Claims Staff, Departments of Insurance and other regulatory agencies, NICB and other industry investigative representatives.
• Makes sure all SIU investigation files include a concise and complete summary of the investigation, including the investigators findings regarding the suspected insurance fraud and the basis for their findings and ensure that all investigative cases are thoroughly, promptly, and efficiently investigated and referred to the proper authority within the timeframe as mandated.
• Works with all members of the Claims Management, Underwriting and Marketing Teams, Claim Support Staff, Independent Vendors, Defense Counsel, and all other entities as may be required, to ensure effective implementation of fraud detection and deterrent protocols.
• Aids in the training of Central Mutual Insurance anti-fraud personnel and Claims Staff in fraud detection, prevention, and suspect claim handling measures.
• Represents the Company at various industry, state and local organizations which focus on anti-fraud activities.
• Coordinates investigation of complex suspect claims and assignments as warranted ensuring proper resolution and documentation within case management system.
• Collaborates with the SIU Director on all matters of the SIU function to include, but not limited to; investigation, investigative strategy, training and other department matters.
• Oversees reporting of all suspected fraudulent insurance transactions to the appropriate departments of insurance within the required time frames for their team.
• Selects, trains, and develops new employees.
• Manages staff and other resources appropriately.

Required Qualifications

• Bachelor’s Degree in Criminal Justice, Criminology, or Fraud Management and 2 years relevant experience
• Or 4 years of relevant SIU investigator/SIU Supervisor experience

Preferred Qualifications

• Licensure & Certification: None required; One or more of the following certifications/designations are desirable: Senior Claims Law Associate Designation, Certified Insurance Fraud Investigator Designation, and Certified Fraud Examiners Designation.
• Familiarity with anti-fraud analytics programs as it relates to fraud prevention and identification

Skills and Abilities

• Significant knowledge and experience in all levels of P&C claim fraud investigation and reporting requirements to the various fraud bureaus.
• Advanced practical knowledge of conducting medical and property investigations in the field is necessary.
• Good working knowledge of Word, Excel, and PowerPoint applications.
• Demonstrated ability to build and maintain collaborative relationships with internal and external partners and business areas.
• Prominent management skills.
• Excellent leadership, team building, communication and strategic thinking skills.
• Proven track record in facilitating and managing projects and teams.
• Attain and be very proficient at the SIU protocols and procedures that would include SIU compliance to the specific states the company operates in.
• Possess in-depth knowledge of insurance policies and procedures related to SIU investigations.

Benefits

Central establishes base pay based on several factors including labor market data and an evaluation of candidate qualifications relative to role requirements. Base pay is one component of a comprehensive total rewards package designed to support employees’ financial, health, career, and retirement objectives. Central provides extensive health and wellness benefits to promote flexibility, work-life balance, and long-term financial security.