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Fraud Claims Operations Representative Jobs in Washington

CareFirst

Payment Policy Manager (Hybrid)

Washington, DC · Hybrid

$122K - $131K/yr

  • Retirement

Collaborates with internal and external partners, including provider contracting, claims operations ... Represents the division on matters of payment and reimbursement policy to influence provider ...

Crawford and Company

Claims Specialist-WC

Fairfax, VA · On-site

$16.10 - $29.44/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Evaluates medical claims for potential fraud issues, loss control and recovery in accordance with ... Competitive base pay - The Pay Range/Salary represents the anticipated low and high pay that may be ...

WesBanco Bank, Inc.

Client Relationship Officer

Bowie, MD · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... fraud claims Identifies cross-selling opportunities, recommending additional bank products and ... Collaborates with Loan Operations, Treasury Management and Deposit Operations to ensure ongoing ...

WESBANCO

Client Relationship Officer

Bowie, MD · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... fraud claims Identifies cross-selling opportunities, recommending additional bank products and ... Collaborates with Loan Operations, Treasury Management and Deposit Operations to ensure ongoing ...

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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 Washington?

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

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

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

Fraud Claims Operations Representative jobs near you

Senior Claims Adjuster, TPA Oversight

LotSolutions, Inc.

Washington, DC

$100K - $130K/yr

Full-time

Re-posted 5 days ago

Job description

The Senior Claims Adjuster, TPA Oversight will provide technical expertise and handle a wide variety of severity/complex claims as well as coverage litigation within Commercial Auto, Cargo, and Crane & Rigging lines of business. Additionally, they will complement the existing Specialty Claims team that supports the Underwriting unit and will provide oversight of third parties and delegated authority referrals.

Minimum Qualifications:

  • A Bachelor’s degree or the equivalent education and/or experience.
  • 5-10 years of relevant and progressive experience handling Commercial Auto and General Liability claims.
  • Adjuster licenses, as mandated by specific states, are required.

Primary Job Functions:

  • Handle claims originating out of the Specialty Claims unit and provide technical oversight of Third Party Administrators (TPAs).
  • Direct oversight of commercial auto and specialty transport claims and coverage disputes.
  • Provide coverage, liability, and damages analysis with prompt identification of potential large loss claims.
  • Responsible for ensuring adequate reserving and accuracy of claims payments through appropriate supervision and authority levels.
  • Work in partnership with the TPA Claims Manager to ensure that claims are proactively managed and that all claim workflows and SLAs are adhered to.
  • Ensure timely disposition of all claims in accordance with regulatory and statutory requirements.
  • Ability to proactively identify exposures and claim trends which may affect the portfolio and provide written assessments to the Specialty business unit.
  • Resolve problems and respond to coverage questions from underwriting team and senior management.
  • Build and maintain key relationships with internal and external stakeholders (e.g. Reinsurers, Underwriters, Actuarial, Brokers, Attorneys, Vendors, etc.).
  • Effectively represent the Company’s interests at mediations and settlement conferences.
  • Other duties as required by management.
  • Participate in Claim Reviews and claim audits periodically.
  • Attend depositions, settlement conferences and trials when necessary periodically.
  • Performs other duties or special projects as required or as assigned by a supervisor periodically.

The above cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.

Skills & Competencies Required:

  • Excellent written and verbal communication skills.
  • Strong analytical skills.
  • Strong negotiation skills.
  • In-depth knowledge of claims, litigation, and trial process.
  • Strong commitment to providing superior client service.
  • Excellent organizational and time management skills.
  • Proficiency in MS Office (Word, Excel, Outlook).
  • Ability to work independently with limited supervision.
  • Ability to successfully obtain the required state adjusters’ licenses.

Additional Information:

  • Full benefit package including medical, dental, life, vision, company paid short/long term disability, 401(k), tuition assistance and more.
  • The anticipated salary for this position is $100,000 - $130,000 per year, based on qualifications and experience.
  • Internal Notice: As part of our commitment to talent development, this position is open for internal promotion applications at the time of public posting.
  • Fortegra is not accepting unsolicited resumes from search firms for this position.
  • Please be aware of job fraud(s) – all correspondence emails regarding your candidacy will come from our Fortegra.com email address. Thank you.