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Fraud Claims Operations Representative Jobs in Tennessee

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Fraud Claims Operations Representative information

What are the key skills and qualifications needed to thrive as a fraud claims operations representative, and why are they important?

To thrive as a Fraud Claims Operations Representative, you need strong analytical skills, attention to detail, and experience in financial services or fraud investigation, often supported by a relevant associate's or bachelor's degree. Familiarity with fraud detection software, case management systems, and banking platforms is typically required. Excellent communication, problem-solving, and customer service skills help you resolve claims efficiently and reassure affected clients. These skills are essential for accurately identifying fraudulent activity, mitigating losses, and maintaining customer trust in financial institutions.

How does a fraud claims operations representative typically collaborate with other departments during an investigation?

Fraud Claims Operations Representatives regularly work with teams such as Customer Service, Risk Management, and IT Security to thoroughly investigate and resolve fraud cases. Collaboration often involves sharing detailed case information, coordinating on account holds or restrictions, and ensuring that customers are kept informed throughout the process. Effective communication and teamwork are essential, as representatives must often escalate complex cases or seek specialized expertise from other departments to reach a resolution promptly.

What does a fraud claims operations representative do?

A Fraud Claims Operations Representative is responsible for investigating and resolving claims related to fraudulent activities on customer accounts. They review transaction details, communicate with customers to gather information, and determine the validity of reported fraud. Their work helps protect both the financial institution and its customers from financial losses due to unauthorized or suspicious activity. They also ensure compliance with company policies and legal regulations during the claims process.

What are popular job titles related to Fraud Claims Operations Representative jobs in Tennessee?

For Fraud Claims Operations Representative jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Fraud Claims Operations Representative jobs in Tennessee look for?

The top searched job categories for Fraud Claims Operations Representative jobs in Tennessee are:

What cities in Tennessee are hiring for Fraud Claims Operations Representative jobs?

Cities in Tennessee with the most Fraud Claims Operations Representative job openings:

Fraud Claims Operations Representative jobs near you

Casualty Specialist II

First Acceptance Corporation

Memphis, TN • On-site, Remote

Full-time

Re-posted 12 days ago

Job description

RESPONSIBILITY
  • Plans and/or conducts investigations to analyze coverage and determine liability, compensability, and extent of damages.
  • Completes Bodily Injury Evaluation forms and/or makes recommendations for the disposition of claims in excess of individual settlement authority.
  • Compiles information for discussion and decision-making by the claims committee where appropriate.
  • Determines the need for independent adjusters, cause and origin experts, independent medical examiners, economists, accident re-constructionists, and engineers. Assesses actual damages associated with claims and conducts negotiations to settle claims.
  • Determines if subrogation is appropriate and takes steps necessary to initiate recovery efforts.
  • Evaluates policy coverage, and contacts insureds, claimants, attorneys, body shops and medical staff to determine injuries stemming from an accident while determining and establishing reserve requirements.
  • Evaluates the medical injury exposure within guidelines, obtaining authority when appropriate, and makes proper and timely payments.
  • Maintains accurate records and handles administrative responsibilities associated with the processing and payment of claims.
  • Records/updates status notes and documents results of contacts, the duration of contacts and relevant medical information; reports are consistent with internal procedures and best practices.
  • Maintains computer log indicating results of claim review and intentions for claim handling.
  • Keeps internal and/or external customers advised of file status and other matters as required.
  • Responds timely and appropriately to all settlement demands.
  • Evaluates each claim for potential fraud and works with Special Investigations Unit as required.? Performs other duties as assigned.

JOB REQUIREMENTS
  • High School Diploma or equivalency required.
  • A 2-year degree or higher in a field related to the position is preferred.
  • At least one year of automobile liability experience is required.
  • A minimum of 2 years of previous auto liability claim handling experience or minimum 1 year of bodily injury claims experience is preferred.
  • Must currently hold or have the ability to secure and maintain adjuster license(s) within 60 days of employment.
  • Knowledge and understanding of applicable insurance statutes, regulations and case law.
  • Insurance industry knowledge.
  • Proficiency in Microsoft Office Suite products such as Word, Excel, PowerPoint, etc.
  • Strong customer service skills. Time management, prioritization, and organizational skills.
  • Ability to make effective decisions on behalf of the organization with regards to casualty claims processing.
  • Ability to think critically and anticipate, recognize, identify, and develop solutions to problems in a timely manner.
  • Excellent interpersonal and communication skills, including presentation skills.
  • Commitment to First Acceptance's company values.

PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to do manual tasks, which may include the use of hands to finger and handle controls. Tasks may also require the ability to talk or hear. The employee will frequently sit, bend, and reach with hands and arms and is occasionally required to stand and walk. Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus. The employee may occasionally lift and/or move up to 10 pounds. Other abilities include possessing the capacity to learn, concentrate, think, and read. Oftentimes the employee will be communicating and interacting with others while working.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employee(s) will be required to follow any other job-related instructions and perform any other job-related duties requested by anyone authorized to give instructions or assignments.
#LI-REMOTE
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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