Claims Fraud Investigator

Company: Zurich Insurance Company Ltd.
Location: Oakland
Posted on: June 23, 2022

Job Description:

Under general direction and with moderate limits and authority conducts the investigation of suspected fraud and varying degrees of complex cases within an assigned geographic region. Is responsible for delivering high quality and professional investigation reports with decisive conclusions and technically excellent content to ensure that all claims fraud risks are effectively and efficiently governed and managed. - - Additional responsibilities will include: - Conducts fraud investigations within an assigned geography or Line Of Business in the local Business Unit, or outside normal geography/Line Of Business, as required. Investigates all aspects of claims referred for investigation, including circumstances of loss, background of individuals/businesses and underwriting aspects Research information and database searches, prepares surveillance assignment, assigns to vendor and reviews results with subsequent documentation. Gathers information from various sources and interviews witnesses. Maintains impeccable documentation, back up and files to support all aspects of the case. Secures recorded and signed statements. Evaluates information and evidence in the determination of fraud for assigned cases. Gathers evidence in a prescribed format which would be required should the matter proceed to arbitration, legal process or criminal prosecution. Prepares and provides investigative reports to Claims, Management, Business Partners, Global Claims or outside agencies including recommendation as to outcome of investigation and whether claim is fraudulent. Acquire and efficiently organize the relevant evidence and information necessary to accurately assess whether or not there is a fraudulent aspect to individual or fraud network claims. Liaising closely with senior managers and claim handlers throughout the investigative process and ensuring that all stakeholders are immediately aware of any important issues that are identified. Identify promptly cases which need to be escalated to the senior staff. Adheres 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. - - Basic Qualifications: - Bachelor's Degree and 4 or more years of experience in the Technical Claims Investigations, Law Enforcement or Insurance Special Investigations area OR Zurich Certified Insurance Apprentice, including an Associate Degree and 4 or more years of experience in the Technical Claims Investigations, Law Enforcement or Insurance Special Investigations area OR High School Diploma or Equivalent and 6 or more years of experience in the Technical Claims Investigations, Law Enforcement or Insurance Special Investigations area - AND Knowledge of regulations and statutes pertaining to claims law Knowledge of claims process Microsoft Office experience - Preferred Qualifications: - Strong written and verbal communication skills Strong organization and prioritization skills Detail oriented Previous SIU Field Experience - As a condition of employment at Zurich, employees must adhere to our COVID-related health and safety protocols ( ), including, without limitation, a requirement that employees attest as to their vaccination status with a YES/NO, and upload proof of vaccination status, or a negative COVID test result when applicable, to a third-party vendor. These protocols are continuously re-evaluated and the requirements may change at any time. - 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 - California Virtual Office Remote Working: Yes Schedule: Full Time - Linkedin Recruiter Tag: #LI- LC

Keywords: Zurich Insurance Company Ltd., Oakland , Claims Fraud Investigator, Other , Oakland, California