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