Claims Specialist III SIU Field Investigator

Profile

Claims Specialist III, SIU Field Investigator
Duties: Independently conducts complex investigations of suspicious or unlawful activity directed at policyholder and corporate assets in a prompt and expeditious manner. Reviews and makes recommendations on outcomes of investigations in a prompt and expeditious manner. Provides guidance and recommendations to claims leadership and associates on claims resolution. Promotes and provides “On Your Side” customer service. Continuously monitors suspicious claims and claims payment operations in pursuit of fraudulent activities and the prevention of future fraudulent payments. Keeps management informed of developments that impact claims results in assigned region. Represents Nationwide by testifying in civil and criminal court proceedings as needed. Maintains assigned claims files in a confidential manner; documents all relevant facts pertaining to files in the appropriate claims handling system(s). Investigates assigned claims suspected of insurance fraud, this includes but is not limited to: PIP, large loss, large loss fire, and multiple claims. Geographic location may impact work load. Maintains and pursues technical competency within area of specialization by attending insurance fraud seminars and other company-sponsored courses at the direction of the Special Investigation Unit Leadership. May provide investigative guidance to Special Investigator team members.. Anticipates training needs of customers based on customer exposure and antifraud initiatives. May partner with Special Investigation Unit Training to develop and deliver training to internal and external audiences regarding fraud awareness. Submits expense reports and other administrative reports as required and maintains assigned company equipment. Produces investigative reports for Special Investigation Unit Manager and customers through data mining, pattern analysis and trending claims information. Regularly attends/initiates meetings with Claims Management. May attend Claim Leadership Team meetings. Proactively provides support to claims partners which may include, data mining, analyzing and trending claims information and claims consultation/training on claims and investigative changes/impacts leading to increased awareness of suspicious claims. Ensures that assigned cases are investigated and reported back to the requesting party in adherence to Special Investigation Unit Best Practices. Develops and maintains rapport and cooperation with federal, state and local government agencies, as well as private information bureaus that can assist in investigative efforts. Independently concludes investigations in adherence to Special Investigation Unit Best Practices. May utilize expertise of an outside vendor to assist with investigation and consult with a large loss specialist. Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective Nationwide customers. Performs other duties as assigned.

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