ESIS ProClaim Senior Representative, A&H (Hybrid)

JOB DESCRIPTION

Overall Role Responsibilities:

The Claims Investigator position is responsible for identifying trends related to fraudulent claims activity, monitoring high-risk markets, and establishing and maintaining relationships with vendors to effective conduct fraud investigations.

The Fraud Examiner will play a crucial role in detecting, investigating, and preventing fraudulent activities, safeguarding the program's reputation, and minimizing financial losses.

This position will also provide support to management by completing assigned tasks related to claims handling, compliance, reporting, and data analytics.

Fraud Detection and Investigation:


* Analyze data and identify patterns, trends, and anomalies indicative of potential fraudulent activity.


* Conduct thorough investigations into suspected fraud cases, gathering evidence, documenting findings, and recommending appropriate actions to the claims team.


* Coordinate with the client and external partners to enhance fraud prevention and investigation strategies.


* Continuously evaluate existing fraud detection tools and techniques, exploring new technologies and methodologies to enhance fraud detection capabilities.


* Establish fraud claims handling processes, workflows, and best practices.

Ensure compliance by the claims team through audits and coaching.

Market Monitoring:


* Identify high-risk markets and sectors prone to fraudulent activities based on historical data and industry reports.


* Develop and maintain a detailed understanding of fraud trends prevalent in identified markets.


* Regularly monitor and assess fraud risks associated with specific markets, implementing proactive measures to minimize the impact of fraudulent activities.

Vendor Management:


* Establish and maintain relationships with vendors providing fraud investigation services.


* Collaborate with vendors to define clear expectations, service level agreements, and deliverables.


* Regularly evaluate vendor performance to ensure quality, accuracy, and timeliness of investigations.


* Develop and maintain a network of alternative vendor partnerships to ensure options for scaling or replacing vendors as needed.

Reporting and Documentation:


* Prepare comprehensive reports and documentation summarizing fraud investigations, methodologies used, and outcomes.


* Present findings and recommendations to management, providing insights to enhance fraud prevention measures.


* Maintain accurate records, organizing and archiving information to ensure compliance with internal policies and regulatory requirements.

QUALIFICATIONS



* Two

ABOUT US

Chubb is a world leader in insurance.

With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients.

The company is distinguished by i...