Claims Fraud and Investigations Manager

Zurich North America is seeking a Claims Fraud and Investigations Manager to support our Zurich Claims Investigative Services.

At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when it comes to choosing your next career move. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location, while facilitating in-person connections and collaborative activities when meaningful and valuable. While the model provides a high level of flexibility and autonomy, occasional circumstances requiring in-office attendance should be expected.  This is a fully remote role and can reside anywhere in the United States.

The Claims Fraud and Investigations Manager is responsible for managing the daily activities of the Claims Fraud Investigations Team in order to prevent, detect and investigate suspected external fraud against the organization and its customers, to ensure that all claims fraud risks are effectively and efficiently governed and managed.

Additional responsibilities may include:

• Providing first class and effective Claims Investigation services to Business Unit Claims function and beyond, by delivering high quality and professional investigation reports with decisive conclusions and technically excellent content.
• Providing operational and technical management of teams of investigators and work alongside the Head of Claims Fraud & Investigations in the BU to develop strategy and maximize savings in areas of responsibility.
• Actively monitoring and steer highly complex cases (assigned or escalated to you) that include large loss, multi-claim, complex investigations in commercial lines.
• Handling technical referrals, complaints and work closely with internal audit on Claims Fraud Investigation performance.
• Conducting quarterly quality audits of closed investigations performed by the team, as well as occasional audits/reviews of open files.
• Training the team & Claims Partners in how to identify, investigate and document/report fraudulent claims.
• Serving as day-to-day contact with Business Unit Claims managers to ensure effective execution of fraud investigations.
• Adhering to local regulation and Zurich Claims governance requirements throughout the investigative process to ensure that all information and data is obtained within data protection rules and regulations.
• Collating and analyze accurate fraud data to provide information and Management Information for internal communications in order to support ongoing promotion of, and adherence to the claim’s fraud strategy.
• Acting as the liaison between Claims Fraud Investigation team and Human Resources group on all Human Resources/ personnel issues

Basic Qualifications:

• Bachelor's degree and 6 or more years of experience in the Insurance Fraud or Insurance Investigations area
   OR

• Zurich Certified Insurance Apprentice, including an Associate Degree and 6 or more years of experience in the Insurance Fraud or Insurance Investigations area
   OR
• High School Diploma or Equivalent and 8 or more years of experience in the Insurance Fraud or Insurance Investigations area in commercial insurance.
  AND
• Leadership experience.
• Project management experience
• Must obtain and retain anti-fraud certification
• Knowledge of commercial claims handling processes and procedures.
• Experience in interpreting and applying state fraud statutes and regulations.

Preferred Qualifications

• Highly preferred experiences in commercial insurance in one of the following:  Auto, GL, WC, Property, Auto Finance, Transportation (Inland/Ocean), CAT coordination.
• Experience working organizational development projects:  Process improvement & streamlining, Quality assurance development, innovation tech research, review.
• Experience implementing process and procedures, developing metrics for fraud teams and measuring claims participation in fraud programs.
• Industry partnerships (IASIU, NICB, CAIF, etc.):  Engaged with at least one of these groups consistently throughout their SIU career.
• Experience responding to Law Enforcement and/or regulatory compliance questions/requests.
• Experience engaging directly with commercial accounts, leading the partnership with account executives.
• Ability to present to business partners and claims leadership.
• Strong verbal and written communication skills
• People management experience
• Experience collaborating in a team environment and across business units
• Data & Analytics driven:  Experience reviewing predictive modeling results and providing constructive feedback to improve the model.

Compensation for roles at Zurich varies depending on a wide array of factors including but not limited to the specific office location, role, skill set, and level of experience. As required by local law, Zurich provides in good faith a reasonable range of compensation for roles. For additional information about our Total Rewards, Click here. Other rewards may include short term incentive bonuses and merit increases. Candidates with salary expectations outside of the range are encouraged to apply, and will be considered based on experience, skill, and education. The salary provided is a nationwide market range and has not been adjusted for the applicable geographic differential associated with the location where the position may be filled. The starting salary range for this position is $96,300.00 - $157,700.00.

As an insurance company, Zurich is subject to 18 U.S. Code § 1033. 
 

As a condition of employment at Zurich, employees must adhere to any COVID-related health and safety protocols in place at that time (https://www.zurichna.com/careers/faq).

A future with Zurich. What can go right when you apply at Zurich?

Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please click here to learn more.

As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers’ expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet 

Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission. 

Location(s): AM - Georgia Virtual Office, AM - Remote Work (US)
Remote Working: Yes
Schedule: Full Time
Employment Sponsorship Offered: No 
 
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