Insurance Expert

Job Summary

Join our customer's team as an Insurance Expert, where your in-depth knowledge of claims management and fraud prevention will help elevate operational standards and safeguard against risk. This role is ideal for professionals who thrive in dynamic, remote environments and are passionate about leveraging industry best practices to protect both customers and the business.

Key Responsibilities

• Oversee and optimize end-to-end claims management workflows to ensure efficiency and accuracy.
• Conduct comprehensive investigations into suspicious claims, utilizing Special Investigation Unit (SIU) methodologies.
• Collaborate closely with cross-functional teams to strengthen fraud detection and prevention processes.
• Identify, analyze, and report trends in fraudulent activity, recommending actionable improvements.
• Prepare and deliver clear, concise documentation and reports for both technical and non-technical audiences.
• Support the development and implementation of training related to claims and fraud protocols.
• Maintain thorough, up-to-date knowledge of regulatory compliance and insurance industry standards.

Required Skills and Qualifications

• Demonstrated expertise in insurance claims management and workflow optimization.
• Extensive experience in fraud detection, risk assessment, and SIU investigations.
• Exceptional written and verbal communication skills, with the ability to distill complex data clearly.
• Strong analytical mindset with attention to detail and high ethical standards.
• Ability to work effectively in a remote, part-time capacity while maintaining high levels of productivity.
• Proven track record of collaborating across departments to drive results.
• Proficiency with industry-specific technology platforms and claim management tools.

Preferred Qualifications

• Professional certifications such as CPCU, AIC, or CIFI.
• Experience training or mentoring others in claims or fraud prevention best practices.
• Knowledge of emerging trends and technologies in insurance fraud detection.

Key skills/competency

• Claims Management
• Fraud Prevention
• SIU Investigations
• Risk Assessment
• Regulatory Compliance
• Workflow Optimization
• Data Analysis
• Cross-functional Collaboration
• Insurance Industry Standards
• Communication Skills