Fraud Investigation and Claims Management Specialist

2 weeks ago

North Haven, Connecticut, United States The Ladders Full time
Join Our Team at The Ladders

We are a prominent player in the investigative sector, currently seeking a seasoned Fraud Investigation and Claims Management Specialist to join our operations team. This is a full-time, remote opportunity for the right candidate. Our leadership comprises entrepreneurial and skilled investigators who are committed to fostering a motivational work environment, with a proven track record in recruiting, developing, and guiding high-performing teams.

Position Overview:

The Fraud Investigation and Claims Management Specialist plays a crucial role in overseeing a designated group of field investigators and an Assistant Case Manager. This position is essential for ensuring that our clients receive top-notch investigative services promptly. Success in this role hinges on effective planning, organization, resource management, and continuous training of the assigned personnel. The Specialist must embody the company’s vision and adeptly communicate and implement strategies that align with this vision. Leadership through role modeling and mentoring is a key expectation, along with the ability to thrive in a dynamic, independent work environment.

Key Responsibilities:
  1. Supervise and guide investigative field personnel and other direct reports to cultivate a motivated, quality-driven investigative team capable of handling various insurance claims, including workers' compensation, general liability, property and casualty, disability, and health care.
  2. Maintain a performance-oriented business unit that meets productivity and quality benchmarks through effective training, performance management, and resource allocation. Conduct performance evaluations and development plans as necessary, ensuring proper documentation for all team members.
  3. Conduct quality assurance reviews of investigative work, ensuring adherence to client-specific instructions and timely completion of case objectives. Manage assigned cases through to closure while maintaining organized and accurate case files.
  4. Facilitate effective communication with field staff and clients regarding case progress, making informed recommendations for further actions. Foster strong working relationships with colleagues and management, keeping leadership informed about regional activities.
  5. Uphold confidentiality regarding all information obtained through investigative efforts.
  6. Stay updated on professional knowledge and technical skills through ongoing education, industry seminars, and membership in relevant organizations.
  7. Provide testimony as required regarding facts gathered in any legal proceedings.
  8. Undertake additional assignments and projects as directed by management.
Required Skills and Qualifications:
  • Comprehensive knowledge of investigative methodologies necessary for managing advanced investigations, including various SIU/Claims assignments.
  • Exceptional written and verbal communication abilities, along with strong interpersonal skills.
  • Proficient organizational and time management skills, with a proven ability to effectively manage work assignments and resources.
  • Creative problem-solving skills and a keen eye for identifying opportunities.
  • Ability to provide and receive constructive feedback positively.
  • Demonstrated success in building and managing effective teams.
  • Proficient in Microsoft Office, Internet Explorer, Adobe Acrobat, and case management software.
Qualifications:
  • Bachelor's degree in criminal justice or a related field is preferred but not mandatory.
  • A minimum of five years of experience in conducting complex insurance investigations. (Four additional years of proven performance as an investigator may substitute for educational requirements.)
  • At least three years of supervisory experience.
  • Possession of a private investigator's license or eligibility for licensing in the relevant states.
  • Willingness to travel as needed.
Work Environment:

This position is primarily office-based, with regular requirements to sit for extended periods and operate a computer. Frequent communication with supervisors, clients, and staff will occur via telephone, video conferencing, and email. Occasional travel may be necessary based on business needs.

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