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centralins

Anti-Fraud Manager

Waltham, MA · On-site +1

Senior Claims Law Associate Designation, Certified Insurance Fraud Investigator Designation, and Certified Fraud Examiners Designation. * Familiarity with anti-fraud analytics programs as it relates ...

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Anti-Fraud Manager

centralins

Waltham, MA • On-site, Remote

Other

Medical, Retirement

Re-posted 3 days ago

Job description

Location: Van Wert, OH; Dublin, OH; Waltham, MA; Alpharetta, GA; Irving, TX
Work Model: Hybrid or Remote based on location 
Position type: Full time - salary 

We’re a team of employees passionate about delivering best-in-class customer service and innovation in the industry. Integrity, relationships, and excellence are at the heart of everything we do.

Our employees fully utilize their talents and bring their best selves to work. We believe who you are is just as important as what you do!

Fraud prevention is at the heart of protecting our customers and our business—and that’s where this role makes an impact. As Anti-Fraud Manager, you’ll lead front-line investigative efforts, tackle complex and high-impact cases, and partner with a wide network of internal teams and external agencies. This is an opportunity to shape strategy, develop talent, and bring modern tools and analytics into real-world fraud detection and deterrence.

 Key Responsibilities of the Role  

  • Supervises the day-to-day investigative activity of SIU field/desk investigations and support activities throughout regions. 
  • Acts as the direct liaison with the various Claims Staff, Departments of Insurance and other regulatory agencies, NICB and other industry investigative representatives.
  • Monitors and evaluates the quality of performance and key results through ongoing audits and review of results of both direct adjuster and advanced cutting edge analytic referrals of both artificial intelligence and machine learning.
  • Reviews and evaluates all available information to assess the appropriateness of referrals for prosecution and/or recovery. 
  • Ensures that all SIU investigation files include a concise and complete summary of the investigation, including the investigators findings regarding the suspected insurance fraud and the basis for their findings and ensure that all investigative cases are thoroughly, promptly, and efficiently investigated and referred to the proper authority within the timeframe as mandated. 
  • Works with all members of the Claims Management, Underwriting and Marketing Teams, Claim Support Staff, Independent Vendors, Defense Counsel, and all other entities as may be required, to ensure effective implementation of fraud detection and deterrent protocols.
  • Assists with the training of Central Mutual Insurance anti-fraud personnel and Claims Staff in fraud detection, prevention, and suspect claim handling measures.  
  • Represents the Company at various industry, state and local organizations which focus on anti-fraud activities.
  • Coordinates investigation of complex suspect claims and assignments as warranted ensuring proper resolution and documentation within case management system.  
  • Collaborates with the SIU Director on all matters of the SIU function to include, but not limited to; investigation, investigative strategy, training and other department matters.
  • Oversees reporting of all suspected fraudulent insurance transactions to the appropriate departments of insurance within the required time frames for their team. 
  • Establishes and maintains relationships with law enforcement, Department of Insurance officials and insurance industry personnel and assist them when required.
  • Selects, trains, and develops new employees
  • Sets expectations with regards to performance
  • Communicates with, motivate and recognize employees
  • Evaluates performance and conducts weekly check-ins and performance reviews
  • Manages staff and other resources appropriately 

Required Qualifications  

  • Bachelor’s Degree in Criminal Justice, Criminology, or Fraud Management and 2 years relevant experience 
  • Or 4 years of relevant SIU investigator/SIU Supervisor experience  


Preferred Qualifications  

  • Licensure & Certification: None required; One or more of the following certifications/designations are desirable: Senior Claims Law Associate Designation, Certified Insurance Fraud Investigator Designation, and Certified Fraud Examiners Designation.
  • Familiarity with anti-fraud analytics programs as it relates to fraud prevention and identification 

 
Knowledge, Skills, and Abilities  

  • SIU Supervisor needs to have significant knowledge and experience in all levels of P&C claim fraud investigation and reporting requirements to the various fraud bureaus.  
  • Advanced practical knowledge of conducting medical and property investigations in the field is necessary
  • Good working knowledge of Word, Excel, and PowerPoint applications
  • Demonstrated ability to build and maintain collaborative relationships with internal and external partners and business areas.
  • Proven management skills
  • Ability to demonstrate monthly productive outcomes from investigations assigned to the SIU team
  • Excellent leadership, team building, communication and strategic thinking skills
  • Ability to prepare and present training sessions
  • Successful track record in facilitating and managing projects and teams
  • Attain and be very proficient at the SIU protocols and procedures that would include SIU compliance to the specific states the company operates in
  • Possess in-depth knowledge of insurance policies and procedures related to SIU investigations
  • As a Team Member at Central Mutual Insurance, you will be part of a growing SIU Team that continues to evolve to be a Best in Class SIU group utilizing state of the art analytic programs. Three keys words guide this unit, Unique, Innovative and Creative
  • Ability to understand Central Insurance’s policies and processes 

Total Rewards

Central establishes base pay based on several factors including labor market data and an evaluation of candidate qualifications relative to role requirements. Base pay is one component of a comprehensive total rewards package designed to support employees’ financial, health, career, and retirement objectives. Central provides extensive health and wellness benefits to promote flexibility, work-life balance, and long-term financial security. For more information, see Central Insurance Benefits

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