About the Role
What You'll Do
- SIU/Fraud Parternships: Serve as the primary point of contact for all external claims SIU partners - Carrier SIU teams, industry groups such as NICB and the Coalition Against Insurance Fraud, and various law enforcement agencies.
- Major Case Investigations: Drive claims outcomes on major case investigations, including EUO and litigation support. Leverage claims expertise and advanced analytical capabilities to identify complex relationships and fraud schemes. Utilize data visualization tools to effectively communicate complex data findings.
- Operational Performance and Collaboration: Develop, implement, and monitor operational health metrics and key performance indicators (KPIs) in collaboration with internal investigations and carrier partner SIU teams. Provide regular updates to key stakeholders, highlighting trends and areas for improvement. Provide expert consultation to external insurance partners on data and reporting best practices, and collaborate on data-driven performance improvement initiatives. Provide data-driven input into the design, documentation, and deployment of SIU processes, ensuring alignment with the various stakeholders.
- Fraud Operations: Manage the fraud operations team responsible for responding to carrier partner SIU inquiries, drive investigation and outcomes on non-major case issues including account review and actioning.
Basic Qualifications
- 8+ years of experience in the insurance industry (carrier, broker, MGU, TPA, etc.) with a focus on claims, claims operations, claims analytics, insurance data strategy, or actuarial roles.
Preferred Qualifications
- 5+ years experience leading claims or fraud teams
- Experience managing complex investigations and supporting various forms of fraud related litigation.
- Analytical and Data Strategy Expertise: Deep familiarity with designing, developing, and utilizing claims-related data, reporting, and analytics; proven experience in developing and implementing fraud strategies, including tool selection and vendor management; able to understand and interpret complex metrics and KPIs.
- Influence, Communication, and Collaboration: Exceptional ability to influence stakeholders at all levels, build strong relationships with internal and external partners, and adapt presentations and messaging to different levels of audience, from individual contributors to senior executive leaders.
- Strategic Thinking and Execution: Proven ability to shape strategy, think big, and understand detail, demonstrating a balance of strategic vision and tactical execution; strong attention to detail while maintaining a fast pace to deliver high-quality results efficiently; highly independent and proactive, with a strong understanding of industry trends and a passion for leveraging data to drive change.
- Change Management Expertise: Significant experience driving major change across large, complex organizations.
For Chicago, IL-based roles: The base salary range for this role is USD$162,000 per year - USD$180,000 per year.
For New York, NY-based roles: The base salary range for this role is USD$180,000 per year - USD$200,000 per year.
For Phoenix, AZ-based roles: The base salary range for this role is USD$144,000 per year - USD$160,000 per year.
For San Francisco, CA-based roles: The base salary range for this role is USD$180,000 per year - USD$200,000 per year.