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Under general direction and oversight, initiates and manages suspected fraudulent claim investigations involving low to medium complexity matters within a line of business and/or geographic region. Collaborates with and supports claim professionals and counsel on the detection, investigation, and litigation of suspected fraudulent claims.
JOB DESCRIPTION:
Essential Duties & Responsibilities
Performs a combination of duties in accordance with departmental guidelines:
Under general direction and oversight, conducts detailed analysis and completes timely investigations of suspected claim fraud by following Best Practice Guidelines and collaborating with insureds, claimants, witnesses and experts
Learning to develop and execute investigation strategy by assessing the situation, collaborating with claim professionals, counsel, experts, insureds, and other stakeholders.
Assists with investigation activities and helps with coordinating and overseeing vendor service partner activities in the field.
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.
May participate in building and enhancing organizational capabilities by developing and participating in the delivery of fraud awareness or regulatory compliance training.
May contribute to knowledge sharing with outside agencies by presenting cases of suspected claim fraud.
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.
Reporting Relationship
Typically Manager or Director
Skills, Knowledge and Abilities
1. General knowledge of property and casualty claim handling practices
2. General knowledge of practices and techniques related to investigations and fact finding
3. Strong interpersonal, oral, and written communication skills
4. Ability to interact and collaborate with internal and external business partners, including outside agencies
5. Developing ability to exercise good judgment and make sound business
6. Detail oriented with strong organization and time management skills
7. Developing problem solving skills
8. Proficiency with Microsoft Office applications and similar business software
9. Ability to adapt to change and value diverse opinions and ideas
10. Ability to travel occasionally (less than 5%)
Education and Experience
1. Bachelor's degree or equivalent professional experience.
2. Up to two (2) years of experience conducting investigations or handling insurance claims preferred.
3. Professional certification or designation related to fraud investigations preferred (e.g., CFE, CIFI, FCLS, FCLA, or similar).
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 $47,000 to $78,000 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.
