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Under minimal direction, initiates and manages suspected fraudulent underwriting and insurance premium investigations involving the highest complexity matters. Provides advice, direction, and support to underwriters, auditors, business unit leadership, corporate investigations and other stakeholders across the organization on the detection, investigation, and litigation of suspected underwriting matters.
JOB DESCRIPTION:
Essential Duties & Responsibilities
Performs a combination of duties in accordance with departmental guidelines:
- Leads the detailed analysis and completion of thorough and timely investigations of suspected underwriting fraud by following Best Practice Guidelines and collaborating with business stakeholders.
- Develops and executes investigation strategy either independently or in collaboration with underwriting professionals, counsel, experts, insureds, and other stakeholders.
- Manages investigation activities independently and/or coordinates/oversees vendor service partner activities in the field.
- Maintains detailed, accurate and timely case records by following established Best Practices for file documentation and by creating comprehensive reports of investigative findings, and conclusions.
- Makes recommendations for resolution by presenting evidence-based findings and proposing solutions of moderate to complex scope.
- Identifies opportunities and participates in the design and implementation of process or procedural improvements.
- Leads or directs efforts to build and enhance and oversees organizational capabilities by developing and delivering fraud awareness or regulatory compliance training and mentoring SIU staff.
- Leads or directs the preparation of cases for appropriate reporting to outside agencies; leads or directs pursuit of criminal or civil actions through gathering and documenting relevant data, organizing and summarizing facts and testifying on behalf of the company in civil or criminal matters.
- Continuously develops knowledge and expertise related to insurance fraud by keeping current on 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 and techniques related to investigations and fact finding. For roles focused in an area of specialty (medical provider investigations), strong technical knowledge of respective specialty practices is required.
- 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, ambiguous matters and develop effective solutions
- Proficiency with Microsoft Office applications and similar business software, and understanding of relational databases information querying techniques
- Ability to adapt to change and value diverse opinions and ideas
- Developing ability to implement change
- 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 in the area of a) insurance fraud, b) law enforcement, c) civil or criminal litigation, or d) similar field.
- Professional certification or designation related to fraud investigations strongly preferred (e.g., CFE, CIFI, FCLS, FCLA, 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.
