**ADDITIONAL INFORMATION - PLEASE READ CAREFULLY**
The information between the asterisks contains specific information about this position while the information after the asterisks contains general information about jobs in this job family at Nationwide.
The person in this position will work out of their home, supporting Southern New Jersey, Maryland, Delaware, and other areas as needed. Required travel is approximately 2-3 days/week, with periodic overnight travel.
The ideal candidate will have the following:
- Extensive Claims and/or Law Enforcement experience
- CIFI or FCLS
JOB SUMMARY: Independently conducts complex investigations of suspicious or unlawful activity directed at policyholder and corporate assets in a prompt and expeditious manner. Reviews and makes recommendations on outcomes of investigations in a prompt and expeditious manner. Provides guidance and recommendations to claims leadership and associates on claims resolution. Promotes and provides "On Your Side" customer service. Continuously monitors suspicious claims and claims payment operations in pursuit of fraudulent activities and the prevention of future fraudulent payments.
RELATIONSHIP: Reports to Reports to Claims Manager/Director
DIRECT REPORTS: None
1. Keeps management informed of developments that impact claims results in assigned region.
2. Represents Nationwide by testifying in civil and criminal court proceedings as needed.
3. Maintains assigned claims files in a confidential manner; documents all relevant facts pertaining to files in the appropriate claims handling system(s).
4. Investigates assigned claims suspected of insurance fraud, this includes but is not limited to, PIP, large loss, large loss fire, and multiple claims. Geographic location may impact work load.
5. Maintains and pursues technical competency within area of specialization by attending insurance fraud seminars and other company-sponsored courses at the direction of the Special Investigation Unit Leadership.
6. May provide investigative guidance to Special Investigator team members.
7. Anticipates training needs of customers based on customer exposure and antifraud initiatives. May partner with Special Investigation Unit Training to develop and deliver training to internal and external audiences regarding fraud awareness.
8. Submits expense reports and other administrative reports as required and maintains assigned company equipment.
9. Produces investigative reports for Special Investigation Unit Manager and customers through data mining, pattern analysis and trending claims information.
10. Regularly attends/initiates meetings with Claims Management. May attend Claim Leadership Team meetings.
11. Proactively provides support to claims partners which may include, data mining, analyzing and trending claims information and claims consultation/training on claims and investigative changes/impacts leading to increased awareness of suspicious claims. Ensures that assigned cases are investigated and reported back to the requesting party in adherence to Special Investigation Unit Best Practices.
12. Develops and maintains rapport and cooperation with federal, state and local government agencies, as well as private information bureaus that can assist in investigative efforts.
13. Independently concludes investigations in adherence to Special Investigation Unit Best Practices. May utilize expertise of an outside vendor to assist with investigation and consult with a large loss specialist.
14. Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective Nationwide customers.
15. Other duties as assigned.
Education: Undergraduate degree or equivalent experience preferred. Advanced degrees in law or related discipline desirable.
Licenses/Designations: Successful completion of required claims certification schools/courses. Professional development such as IIA or CPCU preferred. State licensing where required.
Experience: 5-8 years experience in special investigations involving insurance investigations, private investigations or law enforcement investigations and/or Property/Casualty field claims handling experience. Investigative experience of single line loss of property, material damage, casualty and commercial desired.
Knowledge: Knowledge of SIU operations and processes claims handling, insurance contract and legal issues, and fraud investigation techniques. Preferred experience with multistate laws, regulations and civil recovery. Knowledge of claims business operations including claims process, procedures, best practices, and service levels. Must possess knowledge of Property/Casualty Insurance, such as organization, structure, channels, and business focus for the Special Investigation Unit organization and company. Demonstrated knowledge of current investigative trends and awareness of potential developments impacting Special Investigation Unit. Comprehensive knowledge of State Fraud Statutes and Policy contracts across all businesses (e.g. Property, Casualty, Commercial)
Skills/Competencies: Oral and written communication skills for interaction with vendors, other SIU associates, SIU management, and other areas of claims; negotiation skills for vendor management, program management and/or claims quality calibration. Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience. Proven organizational skills to effectively prioritize increased and more complex workloads. Ability to demonstrate strong but flexible standards and can act different, can be seen as balanced based on the conflicting demands of the position. Demonstrated leadership capabilities to effectively train, coach, and provide feedback to less experienced associates. Proven ability to operate personal computer with proficient use of claims and business software.
Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.
Staffing Exceptions to the above Minimum Job Requirements must be approved by: Business Unit Executive and Human Resources.
Working Conditions: Normal office environment or remote work environment. Representatives may be required to operate an automobile and have a valid driver's license with a safe driving record. Must be willing to work extended hours and to travel with possible overnight requirements. Must be available to work catastrophes (CAT) requiring travel to CAT sites with multiple on-site responsibilities and/or for extended periods of time. Including holidays and weekends.
Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
Nationwide Mutual Insurance Company - 2 years ago
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