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Role Description

This position is bonus eligible and involves investigating suspicious, unlawful, and/or fraudulent activity directed at policyholder and enterprise assets.

• Meet department and individual goals while adhering to all state and federal regulations, company ethics and integrity standards.
• Reviews, assesses, and analyzes suspected fraudulent activity including insurance claims, underwriting, personnel, and other sensitive company-wide matters.
• Plans, reviews, assesses, and prioritizes referrals to the CI&S group.
• Develops investigative action plans for moderately sized and/or moderately complex to complex cases.
• Investigates multiple types of cases, including internal fraud, employee misconduct, claims fraud, agent related fraud, and moderately complex to complex cases with multiple insureds.
• Assists Departments of Insurance and law enforcement agencies with investigations of fraud and agent misconduct on moderately sized and moderately complex cases.
• Consults with business partners, Departments of Insurance, Law Enforcement, and other agencies to provide training and guidance, and investigates and reports fraud as required.
• May coordinate with field representatives and outside agencies as needed.
• Writes investigative reports and communicates risks and trends from fraudulent activities.
• Documents investigation details in the CI&S Case Management system.
• Empowered to make decisions that supplement the case review.
• Make outbound calls and conduct interviews with impacted parties during the case review.

Qualifications

• Good knowledge and understanding of insurance investigations, criminal justice, and/or law enforcement principles and practices.
• Analyze, interpret, and evaluate relevant information to resolve a variety of suspicious, sensitive, and moderately complex to complex investigations.
• Compares alternative courses of action and develops/recommends tactical plans to execute a strategy.
• Influences others and maintains productive working relationships with internal and external partners.
• Persuasively communicate in one-on-one, small group, and large group settings.
• Uses sound judgement and prior experiences to make sound decisions when investigating complex issues with multiple stakeholders.
• Must be honest and ethical and exert a high level of integrity and confidentiality.
• Customer focused; willingness to communicate with customers (internal and external).
• Highly organized and able to handle multiple priorities simultaneously.
• Efficient in navigating CNO systems for research and analysis.

Requirements

• Bachelor's degree or equivalent experience.
• 2-5 years of industry experience with securities, life and/or health insurance.
• Good knowledge of Microsoft Office suite.
• Ability to make recommendations, decisions, and identify when escalation is needed.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) retirement plan with company match
• Short-term & long-term disability insurance
• Paid time-off and corporate holidays
• Paid parental leave
• Company paid life insurance