ProSight Specialty Insurance

  • Claims Technology Operative

    Job Locations US-NJ-Morristown
    Posted Date 3 weeks ago(3/1/2019 11:01 AM)
    Job ID
    2018-1924
    # of Openings
    1
    Category
    Claims
  • Overview

    As the Claims Technology Operative you're at the heart of the Special Investigation Claims Unit.  You use your extensive knowledge base in social media platforms and online fraud investigation to identify, mitigate, reduce and eliminate fraudulent claims.  You are a top performer with excellent investigation, organizational and analytical skills.  You understand the key role technology plays in the investigation and mitigation of claims against our policy holders.  You have the ability to analyze data received from multiple sources and communicate with the rest of the claims team.  In addition to being organized and analytical, you possess the strong business judgment and have the communication skills needed to interact with a variety of people in different situations.  You thrive in our fast-paced environment, embrace challenges and are flexible enough to be successful in a dynamic and growing organization.  

    Responsibilities

    • Identifies and assess claims containing red flag indicators of possible fraudulent activity and high severity losses and other claims of interest
    • Analyze online fraud trends relating to medical professionals, legal professionals and insurance fraud.
    • Initiates complex fraud investigations by collecting information from claim files, SIU investigations and executes the investigation utilizing online resources including all social medial platforms.
    • Assures appropriate retention of meta data relating to investigations
    • Understand the state requirements for SIU reporting requirements and the ability to discern which claims warrant referrals
    • Assist in the develop of additional technology to enhance investigations
    • Ability to manage time and operate under strict time deadlines
    • Ability and willingness to perform after hours investigations to assist our rapid response team
    • Document investigative findings in a written report

    Qualifications

    • Three to five years of experience claims handling experience strongly preferred
    • Highly creative with the ability to intellectually cross reference investigation results to ensure the best outcome
    • The ability to exercise discretion, independent judgement and handle confidential matters
    • Understanding of SIU reporting guidelines for each state
    • Self starter who holds themselves accountable for results
    • Licensed private investigator or SIU Field Investigator experience a plus
    • Bachelor’s degree preferred

     

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