Claims Special Investigation Unit Manager

The Claims Investigation Unit Manager lead the success of investigative operations and provides leadership to the assigned staff. The role ensures appropriate investigations are performed on claims utilizing knowledge of and experience with relevant tools, technologies, and techniques. The role identifies and leverages new sources of data to improve success of fraud analytic and predictive model efforts. The role communicates investigation related information to senior leadership and assist with business planning, processes, vendor selection, and budget management.

#LI-DNI

• Drives the consistent delivery of Special Investigation Unit practices and performance and reviews the acceptance/rejection of claim files and ensures that appropriate investigations are performed, and relevant facts obtained on assigned claims.
• Collaborates with Investigation leader on business planning, processes, guidelines, vendor selection, and budget management activities and identifies risk mitigation strategies, evaluates business technology and enhancement possibilities to support data mining and analytics.
• Performs talent management responsibilities including employee selection, performance management, technical coaching, career development, employee-related issues, employee morale and work environment and sets goals and objectives for team members for achievement of operational results.
• Reviews work quality, customer service, and reviews files, conducts quality assurance file reviews for assigned staff, identifies process improvement and best-practice sharing opportunities and manages priorities and workload distribution and removes barriers that impede progress.
• Gathers, organizes, and analyzes performance data and results, creates reports and communicates results with claims leadership and business partners and identifies and reports performance, trends, and opportunities and makes recommendations regarding areas of improvement.
• Reviews external investigations conducted by the agency contracted with the organization that potentially involves any fraudulent issues.
• Leads and motivates cross functional teams in the development of key initiatives and supports litigation preparation, including attendance at exams under oath (EUO's), depositions, and trials.
• Develops and maintains positive and effective business relationships with vendors, including officials, surveillance vendors, governmental agencies, etc.
• Identifies the training needs of the team, partners with Westfield University to design, develop, and deliver fraud-related training programs to claims professionals, underwriting, and agency personnel.
• Participates in professional industry groups and stays abreast of industry changes, advancements, and jurisdictional issues to communicate, develop, and incorporate best practices into the claims business and shares new information, best practices, and processes.

• 5+ years of Claims Handling and/or Investigative experience.
• Bachelor's degree in Business Administration, Finance, Insurance or related field and/or commensurate work experience.

Location

Hybrid defined as three or more days per week in the office.

Behavioral Competencies

• Action oriented
• Business insight
• Collaborates
• Communicates effectively
• Courage
• Nimble learning