Claim Investigator - CSIU

<p>A career at The Auto Club Group (ACG) can be satisfying, exciting and rewarding. By aligning your professional development with our business objectives, ACG can help you attain your career goals &mdash; and make a difference. Get started by choosing the career that&rsquo;s right for you.</p>

Southfield, MI

The Auto Club Group

AAA was founded over 100 years ago for the purpose of lobbying for driver and passenger rights, fair laws and safer vehicles — all to better promote the love of the open road and the adventure of driving. Since then, AAA has grown to over 50 million members strong, while providing valuable membership services such as roadside assistance. Additionally, AAA has broadened its horizons to include all types of travel-related services, as well as offer a variety of insurance and financial products and services. Today’s AAA is a national federation comprised of more than 50 individual clubs throughout the United States and Canada. Whether you’re traveling around the world or to the corner grocery store, planning a honeymoon or weekend road trip, learning to drive or in need of a battery boost, the best way to begin your journey is with AAA. http://michigan.aaa.com/

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Full-time

Competitive Compensation and Benefits Package

Overview: <p>The Auto Club Group (ACG) provides membership, travel, insurance and financial services offerings to approximately 9 million members and customers across 11 states and 2 U.S. territories through the AAA, Meemic and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.<br /> </p> <p><strong><u>Work Environment:</u></strong></p> <p>Works in a temperature controlled office environment. Occasional exposure to road hazards and temperature extremes.</p> <strong><br /> <u>Compensation</u></strong><br /> The Auto Club Group offers a competitive compensation and benefits packages including a base salary with performance-based incentives; medical/dental/vision insurance, pension, 401(k), generous time off, a complimentary AAA Membership and much more!
Responsibilities: <p>Independently perform comprehensive assessment and investigation of personal lines property &amp; casualty claims for the potential of claim fraud. Maintain a thorough understanding of insurance policies and claim handling practices and procedures, as well as insurance policy eligibility and underwriting requirements. Maintain a comprehensive understanding of claim fraud, including the fraud scenarios and methods by which insureds, claimants, service providers, and other parties may engage in opportunistic fraud, and also the ways in which businesses, professionals and organized crime groups, such as fraud rings, operate. Understand and comply with state laws, regulations, and case law impacting claim fraud and investigation activities.</p> <p>Contact the claim representative assigned to the claim, work with them collaboratively, and keep them informed throughout the claim investigation. Review claims to identify the potential fraud scenarios that might be present, both for claim fraud and also policy premium fraud; complete investigative activities that will help prove or disprove the presence of fraud.</p> <p>Investigative activities may include identifying insureds, claimants, witnesses, service providers, and other parties and completing interviews or recorded statements. Obtain customer records such as utility bills and other documents pertinent to the investigation and when necessary with the permission of the insured. Complete vehicle inspections, home inspections and/or conduct site-visits. Obtain and follow-up on public records, as well as police, fire and other official reports. Complete link analysis to understand the relationships between people, places, and things. Arrange for and attend Examinations Under Oaths. Obtain legal counsel opinion when necessary. Attend court hearings when necessary. Investigative activities may also involve hiring experts for specialized tasks such as home fire cause and origin analysis, surveillance, vehicle accident reconstruction, forensic accounting, and legal counsel, and managing those vendors through setting clear expectations, monitoring results, and reviewing and paying associated expenses. Complete investigations thoroughly but also balance expense costs against the facts and exposure of the claim.</p> <p>Research and investigate fraud collaborators, fraud rings, and potentially fraudulent service businesses and professionals such as medical providers, body shops, attorneys or contractors. Understand and assess the implications of laws, licensing and practices related to those professions and their applicability to identifying and defending against policy and claim fraud.</p> <p>Thoroughly document investigative activities, results, and evidence. Work collaboratively with law enforcement, other insurance carrier special investigation units, attorneys, and other parties. Prepare written investigative summaries and submit findings to the assigned claim handler, management, Underwriters and others.&nbsp;</p> <p>Promote fraud awareness and expertise through liaison, consulting, collaboration, and training of company personnel when assigned.</p>
Requirements: <p><strong>Preferred Qualifications</strong></p> <p><strong><u>Education:</u></strong></p> <ul> <li>Bachelor&rsquo;s degree in Business Administration, Insurance, Criminology or a related field or the equivalent in related work experience.</li> <li>Completion of The Institutes Associates in Claims (AIC), Chartered Property Casualty Underwriter (CPCU), or other insurance coursework.</li> <li>Fraud Claim Law Specialist Certification.</li> <li>Certified Insurance Fraud Investigator Certification.</li> </ul> <p><strong><u>Experience:</u></strong></p> <ul> <li>Work experience in both claims handling as well as fraud investigation.</li> <li>Work experience in vendor, provider, and major case investigations.</li> </ul> <p><strong><u>Knowledge and Skills:</u></strong></p> <ul> <li>Medical injury treatment and medical provider practices as they relate to automobile accidents.</li> </ul> <p><strong>Qualifications</strong></p> <p><strong><u>Required Qualifications (these are the minimum requirements to qualify)</u></strong></p> <p><strong><u>Education (include minimum education and any licensing/certifications):</u></strong></p> <ul> <li>College level coursework in Business Administration, Insurance, Criminology or a related field or the equivalent in related work experience.&nbsp; Bachelor&rsquo;s degree preferred.</li> <li>Possession of a valid State Driver's License.</li> </ul> <p><strong><u>Experience:</u></strong></p> <p><strong>Work experience including one of the following:</strong></p> <ul> <li>Five years of experience as a claim representative handling Auto or Home personal lines property and casualty insurance claims.</li> <li>Three years as an investigator in a claims special investigation unit that investigates fraud in personal lines property &amp; casualty claims.</li> <li>Five years in law enforcement in roles such as detective, auto theft investigator, or arson investigator.</li> </ul> <p><strong>Knowledge of at least one of the following:</strong></p> <ul> <li>Laws and regulations pertaining to insurance, claim handling, crime, and investigative activity.</li> <li>Auto and Home policy coverages, provisions, and eligibility and underwriting rules.</li> <li>Claim handling practices.</li> <li>Claim fraud scenarios and indicators.</li> <li>Fraud investigation techniques and practices.</li> </ul> <p><strong>Ability to perform the following:</strong></p> <ul> <li>Communicate effectively with others in a work environment and with the public (e.g. Police department, vendors, contractors, attorneys, other insurance carrier special investigation units).</li> <li>Analyze policies and claims for relevant provisions and applicability to the claim facts.</li> <li>Investigate claims, define appropriate evidence and obtain supportive documentation.</li> <li>Maintain and continually expend expert knowledge on claim fraud scenarios and indicators.</li> <li>Engage and manage experts to complete specialized tasks.</li> <li>Impart fraud awareness training in a formal or informal setting to other Auto Club Group employees, community groups or related professional organizations.</li> <li>Function effectively and independently in a personal computer environment utilizing word processing, spreadsheet and software systems.</li> <li>Present effective and persuasive testimony in civil and criminal litigation on a regular basis.</li> <li>Prepare and present effective written reports (a written sample may be required at time of interview).</li> <li>Process complex, time sensitive data and information from various sources.</li> <li>Complete multiple complex tasks in a timely fashion and under deadline pressure while working on multiple cases simultaneously.</li> <li>Safely operate a motor vehicle.</li> </ul>