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Fraud Prevention and Detection Manager

2 months ago

Laurel, Montana, United States Plymouth Rock Assurance Full time
Job Summary

The Plymouth Rock Assurance Company is seeking a highly skilled Claims Management Supervisor to oversee the operation of a unit of Special Investigations Unit (SIU) Investigators. The successful candidate will be responsible for directing and controlling the work of remote SIU Investigators, establishing and monitoring unit goals, and promoting teamwork through effective leadership.

Key Responsibilities
  • Direct and Control SIU Investigations: Oversee the work of remote SIU Investigators, ensuring that investigations are conducted in a timely and efficient manner.
  • Establish and Monitor Unit Goals: Set and track key performance indicators (KPIs) for service, production, and work quality, and make adjustments as needed to ensure unit goals are met.
  • Plan and Manage Unit Workflow: Develop and implement plans to manage unit workflow, including the assignment of cases to unit members based on complexity, severity, and volume.
  • Promote Teamwork and Collaboration: Foster a culture of teamwork and collaboration among SIU Investigators, and provide guidance and support to ensure that unit members are working effectively together.
  • Review and Analyze Investigations: Conduct regular reviews of active and closed investigations to identify trends, provide direction, and provide feedback to unit members.
  • Develop and Implement Anti-Fraud Training: Design and deliver anti-fraud training programs to meet established internal and regulatory requirements.
  • Manage Large-Scale Anti-Fraud Initiatives: Oversee the development and implementation of large-scale anti-fraud initiatives, including the coordination of multiple stakeholders and the analysis of data and trends.
  • Conduct Performance Reviews and Counseling: Conduct regular performance reviews and counseling sessions with unit members to ensure that they are meeting performance expectations and to provide guidance and support as needed.
Requirements
  • Minimum 5 Years of SIU Experience: The successful candidate will have a minimum of 5 years of experience in a Special Investigations Unit, with a proven track record of success in investigating and resolving complex claims.
  • Bachelor's Degree from a Four-Year College or University: A bachelor's degree from a four-year college or university is preferred, but not required.
  • Extensive Knowledge of Insurance Regulations: The successful candidate will have extensive knowledge of insurance regulations, including those related to personal and commercial auto and homeowners insurance.
  • Strong Analytical and Problem-Solving Skills: The successful candidate will have strong analytical and problem-solving skills, with the ability to analyze complex data and trends and develop effective solutions.
  • Excellent Communication and Interpersonal Skills: The successful candidate will have excellent communication and interpersonal skills, with the ability to work effectively with multiple stakeholders, including claim and underwriting staff, and to communicate complex information in a clear and concise manner.