Claim Investigator

<p><strong>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.</strong></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.

keywords: work environment,compensation,about acg,investigate,analysis,teamwork,maintain,prepare,compliance,audit,legal,experience,audit,education,compliance,construction,maintain


Competitive Compensation and Benefits Package

Overview: 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.&nbsp;<br /><br /> <div><strong><span style="font-size: medium;">Work Environment</span></strong></div> <div><span style="font-size: medium;">Works in a temperature controlled office environment. &nbsp;Occasional exposure to road hazards and temperature extremes.<br /><br />The Auto Club Group offers a competitive compensation and benefits package including a base salary with performance based incentives; medical/dental/vision insurance, 401(k), generous time off, a complimentary AAA Membership and much more!</span></div>
Responsibilities: <ul> <li><span style="font-size: medium;">Independently perform comprehensive assessment and investigation of personal lines property &amp; casualty claims for the potential of claim fraud.&nbsp; </span></li> <li><span style="font-size: medium;">Maintain a thorough understanding of insurance policies and claim handling practices and procedures, as well as insurance policy eligibility and underwriting requirements. </span></li> <li><span style="font-size: medium;">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.&nbsp; </span></li> <li><span style="font-size: medium;">Understand and comply with state laws, regulations, and case law impacting claim fraud and investigation activities.</span></li> <li><span style="font-size: medium;">Contact the claim representative assigned to the claim, work with them collaboratively, and keep them informed throughout the claim investigation.&nbsp; </span></li> <li><span style="font-size: medium;">Review claims to identify the potential fraud scenarios that might be present, both for claim fraud and also policy premium fraud.&nbsp; </span></li> <li><span style="font-size: medium;">Complete investigative activities that will help prove or disprove the presence of fraud.&nbsp;</span></li> <li><span style="font-size: medium;">Investigative activities may include identifying insureds, claimants, witnesses, service providers, and other parties and completing interviews or recorded statements.&nbsp; </span></li> <li><span style="font-size: medium;">Obtain customer records such as utility bills and other documents pertinent to the investigation and when necessary with the permission of the insured.&nbsp; </span></li> <li><span style="font-size: medium;">Complete vehicle inspections, home inspections, or conduct site-visits.&nbsp; </span></li> <li><span style="font-size: medium;">Obtain and follow-up on public records, as well as police, fire and other official reports. </span></li> <li><span style="font-size: medium;">Complete link analysis to understand the relationships between people, places, and things.&nbsp; </span></li> <li><span style="font-size: medium;">Arrange for and attend Examinations Under Oaths.&nbsp; Obtain legal counsel opinion when necessary.&nbsp; </span></li> <li><span style="font-size: medium;">Attend court hearings when necessary.&nbsp; 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.&nbsp; </span></li> <li><span style="font-size: medium;">Complete investigations thoroughly but also balance expense costs against the facts and exposure of the claim.</span></li> <li><span style="font-size: medium;">Research and investigate fraud collaborators, fraud rings, and potentially fraudulent service businesses and professionals such as medical providers, body shops, attorneys or contractors.&nbsp; </span></li> <li><span style="font-size: medium;">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.</span></li> <li><span style="font-size: medium;">Thoroughly document investigative activities, results, and evidence.&nbsp; </span></li> <li><span style="font-size: medium;">Work collaboratively with law enforcement, other insurance carrier special investigation units, attorneys, and other parties.&nbsp; </span></li> <li><span style="font-size: medium;">Prepare written investigative summaries, and report findings to the assigned claim handler, management, Underwriters and others.&nbsp;</span></li> <li><span style="font-size: medium;">Promote fraud awareness and expertise through liaison, consulting, collaboration, and training of company personnel when assigned.&nbsp;</span></li> </ul> <u><span style="font-size: medium;">Supervisory Responsibilities (briefly describe, if applicable, or indicate None):</span></u><br /> <ul> <li><span style="font-size: medium;">None</span></li> </ul>
Requirements: <p style="font-weight: 300;"><strong><strong style="font-style: inherit;">Preferred Qualifications</strong></strong></p> <p style="font-weight: 300;"><u style="font-style: inherit; font-weight: inherit;">Education:</u></p> <ul style="font-weight: 300;"> <li style="font-style: inherit;">Bachelor&rsquo;s degree in Business Administration, Insurance, Criminology or a related field or the equivalent in related work experience</li> <li style="font-style: inherit;">Completion of The Institutes Associates In Claims (AIC), Chartered Property Casualty Underwriter (CPCU), or other insurance coursework</li> <li style="font-style: inherit;">Fraud Claim Law Specialist Certification</li> <li style="font-style: inherit;">Certified Insurance Fraud Investigator Certification</li> </ul> <p style="font-weight: 300;"><u style="font-style: inherit; font-weight: inherit;">Experience:</u></p> <ul style="font-weight: 300;"> <li style="font-style: inherit;">Work experience in both claims handling as well as fraud investigation with an emphasis on home and auto.</li> </ul> <p style="font-weight: 300;"><u style="font-style: inherit; font-weight: inherit;">Knowledge and Skills:</u></p> <ul style="font-weight: 300;"> <li style="font-style: inherit;">&nbsp;Vehicle construction, repair estimation, repair and body shop industry practices.&nbsp;</li> <li style="font-style: inherit;">&nbsp;Home construction, repair estimation, repair and contractor industry practices</li> </ul> <p><u><span style="font-family: Arial; font-size: medium;"><strong>Required Qualifications (these are the minimum requirements to qualify)</strong></span></u></p> <p><u><span style="font-family: Arial; font-size: medium;"><strong>Education (include minimum education and any licensing/certifications):</strong></span></u></p> <ul> <li><span style="font-family: Arial; font-size: medium;">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.</span></li> <li><span style="font-family: Arial; font-size: medium;">Possession of a valid State Driver's License.</span></li> </ul> <div><u><span style="font-family: Arial; font-size: medium;"><strong>Experience:</strong></span></u></div> <p><span style="font-family: Arial; font-size: medium;">Work experience including one of the following:</span></p> <ul> <li><span style="font-family: Arial; font-size: medium;">Five years of experience as a claim representative handling Auto or Home personal lines property and casualty insurance claims.</span></li> <li><span style="font-family: Arial; font-size: medium;">Three years as an investigator in a claims special investigation unit that investigates fraud in personal lines property &amp; casualty claims</span></li> <li><span style="font-family: Arial; font-size: medium;">Five years in law enforcement in roles such as detective, auto theft investigator, or arson investigator.</span></li> </ul> <div><span style="font-family: Arial; font-size: medium;">Knowledge of at least one of the following:</span></div> <ul> <li><span style="font-family: Arial; font-size: medium;">Laws and regulations pertaining to insurance, claim handling, crime, and investigative activity</span></li> <li><span style="font-family: Arial; font-size: medium;">Auto and Home policy coverages, provisions, and eligibility and underwriting rules</span></li> <li><span style="font-family: Arial; font-size: medium;">Claim handling practices</span></li> <li><span style="font-family: Arial; font-size: medium;">Claim fraud scenarios and indicators</span></li> <li><span style="font-family: Arial; font-size: medium;">Fraud investigation techniques and practices</span></li> </ul> <div><span style="font-family: Arial; font-size: medium;">Ability to perform the following:</span></div> <ul> <li><span style="font-family: Arial; font-size: medium;">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)</span></li> <li><span style="font-family: Arial; font-size: medium;">Analyze policies and claims for relevant provisions and applicability to the claim facts</span></li> <li><span style="font-family: Arial; font-size: medium;">Investigate claims, define appropriate evidence and obtain supportive documentation</span></li> <li><span style="font-family: Arial; font-size: medium;">Maintain and continually expend expert knowledge on claim fraud scenarios and indicators</span></li> <li><span style="font-family: Arial; font-size: medium;">Engage and manage experts to complete specialized tasks</span></li> <li><span style="font-family: Arial; font-size: medium;">Impart fraud awareness training in a formal or informal setting to other aaa employees, community groups or related professional organizations</span></li> <li><span style="font-family: Arial; font-size: medium;">Function effectively and independently in a personal computer environment utilizing word processing, spreadsheet and software systems</span></li> <li><span style="font-family: Arial; font-size: medium;">Present effective and persuasive testimony in civil and criminal litigation on a regular basis</span></li> <li><span style="font-family: Arial; font-size: medium;">Prepare and present effective written reports (a written sample may be required at time of interview)</span></li> <li><span style="font-family: Arial; font-size: medium;">Process complex, time sensitive data and information from various sources</span></li> <li><span style="font-family: Arial; font-size: medium;">Complete multiple complex tasks in a timely fashion and under deadline pressure while working on multiple cases simultaneously</span></li> <li><span style="font-family: Arial; font-size: medium;">Safely operate a motor vehicle&nbsp;</span></li> </ul> <span style="font-family: Arial; font-size: medium;">Important Note: The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements.&nbsp; Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.</span>