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CNA Insurance · 3 weeks ago

SIU Investigator – Underwriting & Premium Fraud

Wyomissing, PA, USA

Full-time

Hybrid

Mid, Senior Level

$54K/yr - $103K/yr

3+ years exp

CNA Insurance is committed to fostering a culture where employees feel valued and empowered. The SIU Investigator will manage and conduct investigations into suspected fraudulent underwriting and insurance premium matters, providing guidance and support to various stakeholders while ensuring compliance with best practices.

FinanceFinancial ServicesInformation ServicesInformation TechnologyInsuranceProperty ManagementReal EstateRisk Management

Responsibilities

Leads the detailed analysis and completion of thorough and timely investigations of suspected underwriting fraud by following Best Practice Guidelines and collaborating with business stakeholders

Develops and executes investigation strategy either independently or in collaboration with underwriting professionals, counsel, experts, insureds, and other stakeholders

Manages investigation activities independently and/or coordinates/oversees vendor service partner activities in the field

Maintains detailed, accurate and timely case records by following established Best Practices for file documentation and by creating comprehensive reports of investigative findings, and conclusions

Makes recommendations for resolution by presenting evidence-based findings and proposing solutions of moderate to complex scope

Identifies opportunities and participates in the design and implementation of process or procedural improvements

Leads or directs efforts to build and enhance and oversees organizational capabilities by developing and delivering fraud awareness or regulatory compliance training and mentoring SIU staff

Leads or directs the preparation of cases for appropriate reporting to outside agencies; leads or directs pursuit of criminal or civil actions through gathering and documenting relevant data, organizing and summarizing facts and testifying on behalf of the company in civil or criminal matters

Continuously develops knowledge and expertise related to insurance fraud by keeping current on related law, regulations, trends, and emerging issues and participating in insurance fraud or related professional associations

Qualification

Insurance fraud investigationsPropertyCasualty claimsTechnical investigation techniquesMicrosoft Office proficiencyProfessional certification in fraudInterpersonal communicationDetail orientedTime managementAdapt

Required

Solid knowledge of property and casualty claim handling practices

Strong technical knowledge of practices and techniques related to investigations and fact finding. For roles focused in an area of specialty (medical provider investigations), strong technical knowledge of respective specialty practices is required

Strong interpersonal, oral, and written communication skills; ability to clearly communicate complex issues

Ability to interact and collaborate with internal and external business partners, including outside agencies

Ability to work independently, exercise good judgment, and make sound business decisions

Detail oriented with strong organization and time management skills

Strong ability to analyze complex, ambiguous matters and develop effective solutions

Proficiency with Microsoft Office applications and similar business software, and understanding of relational databases information querying techniques

Ability to adapt to change and value diverse opinions and ideas

Developing ability to implement change

Ability to travel occasionally (less than 10%)

Bachelor's degree or equivalent professional experience

Minimum of three to five years of experience conducting investigations in the area of a) insurance fraud, b) law enforcement, c) civil or criminal litigation, or d) similar field

Preferred

Professional certification or designation related to fraud investigations strongly preferred (e.g., CFE, CIFI, FCLS, FCLA, or similar)

Benefits

CNA offers a comprehensive and competitive benefits package to help our employees – and their family members – achieve their physical, financial, emotional and social wellbeing goals.