My client operates in 12 states throughout
the Midwest. They have been named an Iowa Top Workplace. For more than a
century, they have offered challenging work, a quality work environment, and
opportunities for personal and professional growth. With hometown values,
their focus is on job satisfaction, professional growth and development,
health, and wellness. They currently offer an opportunity to join their
organization in a newly created position of Fraud Specialist. In this role you
will develop, coordinate, and implement processes and procedures to objectively
investigate and evaluate potentially fraudulent activities related to a claim
to determine if a legitimate claim exists and eliminate waste and abuse in all
lines of the Claims business.
Fraud Specialist Responsibilities
Develops criteria based on analysis of
trends, data, and patterns to identify claims that have the highest potential
of fraudulent activity.
Evaluates information in claims file
against selected criteria to identify claims with potential fraudulent
activity. Utilizes cost/benefit analysis to make recommendations
concerning the pursuit of additional investigation into high potential fraud
claims.
Gathers data to support fraud claim
including completion of relevant field work and coordination with insurance
industry fraud units, counsel, and law enforcement agencies.
Develops fraud awareness training programs
on detection, deterrence, and prevention of fraud for internal and external
audiences as requested. Partners with law enforcement or any related
public and private sectors to increase opportunities to combat insurance fraud.
Develops standardized and repeatable
procedures to ensure consistency when faced with a potential fraud situation.
Fraud Specialist Requirements
A minimum of five years property-casualty
claims adjusting experience.
At least three or more years in a fraud
related role within a claims unit.
Certified Fraud Examiner (CFE) or Certified
Insurance Fraud Investigator (CIFI) preferred.
A minimum of five years medical related
claims experience preferred.
Please contact Scott Thompson for immediate confidential consideration and additional details.
Phone: 515-216-5455
See our website at www.csgrecruiting.com/jobs for a complete listing of nationwide opportunities.
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