You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
Under general direction and oversight, the SIU Consultant initiates and manages suspected fraudulent claim investigations ranging from low to high complexity. This role involves triaging alerts from the predictive model, conducting OSINT and social media investigations, and collaborating with SIU investigators, claims professionals, and legal counsel. Additionally, this position requires monitoring vendor partner relationships and facilitating informational sessions with internal departments to advance fraud identification and prevention efforts. The ideal candidate will be comfortable working with data analytics tools and web-scraping resources to support fraud detection and prevention efforts.
JOB DESCRIPTION:
Essential Duties & Responsibilities
Performs a combination of duties in accordance with departmental guidelines:
Conducts detailed analysis and completes timely investigations of suspected claim fraud by following Best Practice Guidelines.
Develop and execute social media and injury investigation strategies by assessing the situation, collaborating with claim professionals, counsel, experts, insureds, and other stakeholders.
Triages alerts generated by the predictive model and forwards relevant information to claim professionals to assist in investigation and claim resolution.
Manages the vendor relationship and predictive model performance while holding monthly meetings and quarterly stewardship calls to discuss performance metrics and opportunities for improvement.
Maintains thorough, accurate, and timely case records by following established Best Practices for file documentation.
Makes recommendations for claim resolution by presenting findings and proposing solutions of limited scope.
Provides visibility to activities and trends by analyzing, summarizing, and reporting on key metrics; identifies opportunities and participates in the design and implementation of process or procedural improvements.
Participates in building and enhancing organizational capabilities by developing and participating in the delivery of fraud awareness or regulatory compliance training.
Contributes to knowledge sharing with outside agencies by presenting cases of suspected claim fraud.
Continuously develops knowledge and expertise related to insurance fraud by learning about related law, regulations, trends, and emerging issues and participating in insurance fraud or related professional associations.
May perform additional duties as assigned.
Reporting Relationship
Typically, Manager or Director
Skills, Knowledge and Abilities
Solid knowledge of property and casualty claim handling practices.
Strong technical knowledge of practices, techniques, and software related to data and intelligence analysis.
Strong interpersonal, oral, and written communication skills; ability to clearly communicate complex issues.
Ability to interact and collaborate with internal and external business partners, including outside agencies.
Ability to work independently, exercise good judgment, and make sound business decisions.
Detail oriented with strong organization and time management skills.
Strong ability to analyze complex problems and develop effective solutions.
Proficiency with Microsoft Office applications and similar business software, and solid understanding of relational databases information querying techniques.
Ability to adapt to change and value diverse opinions and ideas.
Ability to manage complex, ambiguous matters.
May participate in implementing long term strategies in support of the business.
Ability to travel occasionally (less than 10%).
Education and Experience
Bachelor's degree or equivalent professional experience.
Minimum of three to five years of experience conducting investigations, working with predictive models or handling insurance claims preferred.
Professional certification or designation related to fraud investigations strongly preferred (e.g., CFE, CIFA, or similar).
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In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia,California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees – and their family members – achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA’s benefits, please visit cnabenefits.com.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contactleaveadministration@cna.com.
