Fraud Triage Specialist (Mobile)

This position is responsible for processing claims with risk issues, researching fraud indicators, updating Known Risk lists, and collaborating with colleagues regarding fraud detection topics. In addition to processing within the designated work queues this position will identify risk through analysis and use of off-system data sets.

What will be my duties and responsibilities in this job?

• Research and process claims with Risk Issues, collaborate with SIU investigators, and perform suspected fraud referrals and call backs (as needed). 

• Research and respond to inquiries from internal clients; document claim files as needed to ensure accurate and timely communication with the end customers. 

• Meet or exceed productivity and quality standards for all claim reviews.  

• Assist in identifying risk, fraud and compliance issues and participate in implementing tools and processes to minimize or eliminate these issues.    

• Recognize consistent problem areas and reports to higher level for action.    

• Perform specialized functions related to Fraud detection and prevention. 

• Follow standard reporting procedures and policies driven by the Risk Management team to ensure compliance with all necessary Reporting Requirements. 

• Participate in regularly scheduled meetings/calls with Operations Management Team designed to obtain feedback on the performance of the team and business, and to provide an opportunity to implement any necessary procedural or systematic changes.    

• Provide fraud detection guidance to other team members as needed.  

• Perform required post-decision tasks, including documenting BOLOs, updating negative lists, etc.

• Sets examples for behavioral expectation: attendance, teamwork, and organizational contributions 

• Shift will be Mon - Fri from 1:00pm - 10:00pm EST.

What are the requirements need for this position?

• High School diploma, GED or higher.

• 3+ years of experience in a customer service environment.   

• Ability to attend and pass the required Insurance Adjuster License courses.

• Ability to maintain continuing education requirements necessary to maintain required Licenses. 

• Analytical skills including experience with data and statistical analysis. 

• Proficient in Microsoft Word, Excel, and other Office applications. 

• Ability to work in multi system/functional environment requiring the use of various systems and tools (e.g.: Assurant systems, vendor systems, GRM, risk management reports, specialized websites/portals). 

• Excellent verbal and written communication skills, interpersonal and customer service skills. 

• Demonstrates strong internal and external communication to drive improved performance. 

• Ability to effectively relay accurate and detailed information to various parties via telephone calls, written communication, in team meetings, and training sessions. 

• Able to apply problem solving skills on complex issues for researching and resolving exception. items that have been initiated via various channels.  

• Ability to analyze problems and makes recommendations that impact the team and business. 

What other skills/experience would be helpful to have?

• 2-year degree or equivalent experience.

• Current Insurance Adjuster License. 

• Experience with ePrism and Assurant Mobile Claims.

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