Fraud Specialist

About the role

The Opportunity at USAA involves developing, implementing, and refining an effective P&C Fraud Program. This includes clear and specific procedures, periodic reporting, effective training, and the development and maintenance of fraud auditing systems. It also entails collaboration with other departments to ensure compliance issues are reported and remediated, setting strategy for fraud risk mitigation, and providing executive thought leadership.

Responsibilities

• Develops strategies and plans in partnership with USAA leadership to support USAA fraud strategies.
• Collaborates with other departments to ensure compliance issues are reported to appropriate channels for investigation and remediation.
• Sets strategy for identifying, measuring, and mitigating fraud risk for the Claims SIU organization.
• Provides executive thought leadership to identify potential gaps in the control environment that present fraud risk and vulnerability, and partners with Association-wide stakeholders/leadership in developing and implementing corrective action plans for remediation of risks.
• Maintains sufficient and accurate reporting and metrics providing actionable insights on detection and investigation of insurance fraud matters.
• Acts as a strategic liaison between USAA and the National Insurance Crime Bureau, Law Enforcement, State Insurance Fraud Bureaus, Industry Associations, and other organizations to promote and support insurance fraud prevention.
• Ensures the timely completion of annual state level anti-fraud plans and other required regulatory reports.
• Operationalizes the P&C Fraud Program that enables USAA to meet its legal and regulatory obligations.
• Designs and implements standardized, repeatable, and scalable tools and processes for the SIU ensuring identification of opportunities for efficiency and automation.
• Stays abreast of industry developments, emerging schemes, and technological and regulatory developments, to implement proactive efforts.
• Responsible for the affirmative litigation philosophy and individual decisions on case filing in state or federal venues.
• Defines and measures appropriately scaled goals for the capability to deter, detect and investigate fraudulent activity for P&C.
• Responsible for the oversight and implementation of fraud awareness training programs.

Requirements

• Bachelor's degree; OR 4 years of relevant education and/or experience.
• 10 years of progressive related experience in developing strategies, managing major initiatives to include operational oversight of P&C claims, fraud investigations, claims litigation/legal process & state regulation requirements and delivering results within a complex matrix environment.
• 6 years of people leadership experience in building, managing and/or developing high-performing teams.
• Experience collaborating with key internal and external resources, business partners and stakeholders (including federal/state agencies and Industry Associations/Bureaus), influencing decisions and managing teams to achieve strategic goals.
• Demonstrated success in leading and developing the delivery of cross-functional programs, strategies, and teams ensuring that USAA establishes, deepens, and retains a best-in-class fraud prevention, detection, and investigation posture in a complex and highly regulated environment.
• Executive-level business and technical acumen in the areas of effective claims investigations, claims risk and compliance, integrated change management and front-line communications leading to operational excellence.
• Demonstrated knowledge and compliance with state laws and regulations pertaining to insurance fraud, good faith claims handling or affirmative litigation.
• Comprehensive knowledge of industry-related competitive/regulatory environment and claims/insurance operational risk.
• Experience applying expert P&C knowledge, collaborating with key resources and stakeholders, influencing USAA decisions, and managing work to achieve strategic goals.

Qualifications

• SIU, Fraud (Internal or External), Strategy or Business Risk and Controls experience within the insurance industry.
• Experience working with agencies, external partners (NICB), external vendors (Verisk) and applicable associations.
• Proven ability to lead and develop high-performing teams in a heavily matrixed organization.
• Exceptional communication and executive presence, with the ability to build trust, navigate complex stakeholder environments, and influence at the C-suite level.
• US military experience through military service or a military spouse/domestic partner.

Skills

• Expertise in claims investigations, fraud prevention, and compliance.
• Strong collaboration and leadership skills.
• Ability to manage multiple projects and priorities simultaneously.
• Knowledge of industry trends and regulatory requirements.
• Effective communication and stakeholder management skills.

Benefits

• Comprehensive medical, dental, and vision plans.
• 401(k).
• Pension plan.
• Life insurance.
• Parental benefits.
• Adoption assistance.
• Paid time off program with paid holidays plus 16 paid volunteer hours.
• Variety of wellness programs.
• Career path planning and continuing education.

Pay

The salary range for this position is: $195,230-$351,410.

Schedule

This position can be based in one of the following locations: San Antonio (preferred location), TX, Plano, TX, Phoenix, AZ, Colorado Springs, CO, Charlotte, NC, or Tampa, FL.

Benefits

• Comprehensive medical, dental, and vision plans.
• 401(k).
• Pension plan.
• Life insurance.
• Parental benefits.
• Adoption assistance.
• Paid time off program with paid holidays plus 16 paid volunteer hours.
• Variety of wellness programs.
• Career path planning and continuing education.