Generali Global Assistance · 12 hours ago
SIU Investigator
Pembroke Pines, FL
Full-time
Hybrid
Senior Level
5+ years expGenerali Global Assistance (GGA) is dedicated to helping people explore the world with confidence. The SIU Investigator will play a crucial role in managing complex fraud investigations and supporting Claims Operations in detecting and analyzing suspicious cases.
Elder CareIdentity ManagementInsurance
Responsibilities
Triage and investigation of the most complex/high value alerts reported by Claims Ops
Collaborate with external Investigation Partners
Investigate Fraud patterns reported by other departments: UDW / Actuarial / Finance Teams
Identify suspicious cases / fraud patterns by your own, leveraging data analysis
Support in the detection/triage phases
Support in the Deny process
Contribute to the definition of manual detection procedures in close collaboration with Claims Supervisors/ Managers
Identify new fraud scenarios for fraud training program purposes, anti-fraud tool improvement and manual detection procedures improvement
Completion of the Quarterly Fraud Report: savings amount, investigation status
Contribute to our continuous enrichment of the Fraud KPIs list
Be an active contributor of the Fraud Operational Committees
Act as an anti-fraud expert within the company, supporting peers to continuously improve maturity level
Qualification
Required
High School Diploma or Equivalent (GED) required
Minimum of 5 years of prior knowledge and experience in healthcare and/or insurance field for processing claims and or anti-fraud management
Strong analytical skills required including demonstrated ability to analyze raw data, draw conclusions, and develop actionable recommendations
Knowledge of developing standards, procedures, guidelines etc
Must be able to represent the organization in a professional and knowledgeable manner
Excellent verbal and written communication skills with ability to manage and prioritize multiple tasks
Computer skills necessary to work effectively: Windows Microsoft Word, Excel, and Power Point Proven ability to work under pressure, prioritize work and meet multiple deadlines
Excellent interpersonal and relationship building skills with a proven track record of leadership across functional lines that delivers business results
Excellent problem-solving skills and capability to troubleshoot the most difficult claim issues
Preferred
Experience or demonstrated knowledge of travel insurance, travel assistance or health care/insurance preferred
Benefits
Generous Employer contribution for health, dental, and vision insurance
Paid Maternity and Paternity Leave
Scholarship Program for Employee Dependents
Company match on 401k
Employee Assistance Program (EAP)
Company paid short-term and long-term disability insurance
Company paid life insurance
Voluntary Pet Insurance
Voluntary Legal Benefit
Discounts on travel insurance
Time off policies including vacation days, sick days, personal days, holidays and volunteer days (VTO)
Company
Generali Global Assistance
Generali Global Assistance is a provider of travel insurance and other assistance services.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Chris Carnicelli
Chief Executive Officer, USA
Benoît Kéruzoré
CFO Generali Global Assistance - North America Service & Insurance Industries
Recent News
Company data provided by crunchbase