Auditor/Investigator II

Job Summary

Ensures the integrity and accuracy of claims processes and protocols.

Essential Functions

Conducts routine and impartial audits/investigations from start to closure into customer claims, ensuring accurate and fair assessments of claims validity. Provides customer service by addressing inquiries and concerns, and escalates audit/investigation, as needed. Compiles detailed and organized records of audit/investigation findings, ensuring accuracy and compliance with legal and regulatory requirements. Applies functional knowledge to create and implement strategies to identify and prevent fraudulent activities, safeguarding the integrity of the claims process. Conducts interviews with relevant witnesses, claimants, and other stakeholders to gather additional information and perspectives on claims. Communicates with appropriate internal teams to ensure the proper processing of audits/investigations, while adhering to legal and regulatory standards. Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates. Assists in providing training and support to other auditors/investigators, contributing to the continuous improvement of investigative processes.

Education & Experience

Minimum Bachelor's Degree required. 2 - 4 years of experience required; 5 - 7 years preferred. Certification(s): Certified Fraud Examiner preferred.