Fraud Management Specialist

Title:

Fraud Management Specialist

Company:

Everest National Insurance Company

Job Category:

Claims

Job Description:

Everest Group, Ltd. (Everest), is a leading global reinsurance and insurance provider, operating for nearly 50 years through subsidiaries in North America, Latin America, the UK & Ireland, Continental Europe and Asia Pacific regions. Throughout our history, Everest has maintained its discipline and focuses on creating long-term value through underwriting excellence and strong risk and capital management. Our strengths include extensive product and distribution capabilities, a strong balance sheet, and an innovative culture. Our most critical asset is our people. We offer dynamic training & professional development to our employees. We also offer generous tuition/continuing education reimbursement programs, mentoring opportunities, flexible work arrangements, and Colleague Resource Groups.

About the Role:

The Fraud Management Specialist will play a pivotal role in the organization’s overall fraud mitigation strategy by collaborating with members of our Claims, Underwriting and Premium Audit teams to ensure that any concerns resulting in the need for a field investigation, are addressed via the most suitable investigative solution and by the most qualified investigative partner. They will accomplish this via their oversight of all aspects of the investigation, from the initial referral to the actioning of investigative results that can lead to mitigated outcomes. The position will report to the AVP of Claims Fraud Management and will be based in Warren, NJ.

Role & Responsibilities (include but not limited to): 

• Ensure that all investigations are done in compliance with Everest’s best practices and that all work product is received in a timely manner in accordance with SLAs
• Work with internal SIU staff and external SIU partners to review any investigations that identify possible fraud that could lead to further suspect fraud investigations and/or referral to state agencies
• Oversee all aspects of investigations assigned to investigative vendors
• Review new investigative assignments, assessing concerns and desired outcomes 
• Establishing investigative action plan that addresses concerns with a view to achieving the desired outcomes
• Make assignments to investigative panel member based on expertise, geographic coverage, and vendor’s performance metrics 
• Maintain oversight of assigned investigations to ensure that investigative efforts are in line with the established action plan, while making needed course corrections to ensure best possible outcomes
• Provide assigned investigators with new directives or newly learned intelligence that could help their investigations
• Provides regular status updates to client during investigations as warranted 
• Make recommendations regarding next steps based on investigative results
• Reviews all final investigative reports and collaborate with client to ensure actionable results are acted upon, resulting in best possible claim outcomes 
• Properly document all communication related to the investigation and maintain record of investigative documents via department’s referral database
• Track investigative performance and KPIs

Qualifications: 

• 3-5 years previous investigative or claims experience or a combination of both
• Customer service / client support experience
• Knowledge of claims, loss control, underwriting and premium audit disciplines
• Experience working with diverse internal and external operational and support units, departments and Third Party Administrators
• Expertise in developing and maintaining case management spreadsheets, databases and performance metrics
• Operational knowledge of the ISO, NICB, and public record databases
• Highschool diploma is required, Bachelor's degree in Business Administration, Public Policy, Criminal Justice, or other related field from an accredited college or university is preferred
• Excellent organizational skills with the ability to prioritize and multi-task
• Insurance industry licenses, certifications or registrations such as; CIFI, CFE, SCLA, CAFP, AIS, FCLA, FCLS, CPCU, CIC

Knowledge, Skills & Competencies:  

• Excellent organizational skills with the ability to prioritize and multi-task
• Ability to work effectively with diverse internal and external constituents
• Strong oral and written communication skills.
• Ability to think analytically and strategically
• Highly developed problem solving skills
• Proficiency in Microsoft Office (Word, Excel and PowerPoint)
• Ability to travel occasionally by air/rail as needed to attend training, meetings, or other work-related activities

Our Culture 

At Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors. Click here to learn more about our culture. 

  

• Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Diversity, Equity and Inclusion.  
• Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together.  

  

All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve.  

Type:

Regular

Time Type:

Full time

Primary Location:

Warren, NJ

Additional Locations:

N/A