Manager, Special Investigations – Recovery

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Skyward Specialty Insurance

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2007

🤝 B2B

💸 Finanças

⚕️ Seguro de Saúde

💰 $177.300.000 Post-IPO Secondary - Skyward Specialty em 2024-05

B2B • Finance • Healthcare Insurance

A Skyward Specialty Insurance é um grupo de seguros especializados sediado em Houston que fornece soluções de risco personalizadas para mercados de nicho e complexos. A empresa oferece uma gama de produtos de seguros especializados, incluindo Excesso e Suplementar (E&S) transacional, linhas profissionais, stop-loss médico, caução, cativas, programas, propriedades globais, agricultura e crédito (res)seguros, e consultoria de risco. A Skyward trabalha principalmente com corretores e agentes, aproveita a tecnologia (incluindo capacidades de e-surety) para oferecer serviços inovadores de subscrição e sinistros, e foca em riscos de alta complexidade, não padronizados e soluções especializadas escaláveis.

Descrição

• Overseeing the company’s fraud detection, subrogation, and recovery functions • Coordinating all potential fraud investigations and ensuring compliance with state-level SIU reporting requirements • Using traditional and AI-based fraud detection indicators and other investigative tools • Partnering with adjusters and claims managers to evaluate concerns, determine appropriate investigative strategies, and assign cases to third-party vendors • Reviewing and interpreting claims data and data from third-party vendors to make recommendations for improvements in investigations, processes and outcomes • Using ISO data and predictive models to proactively conduct and/or facilitate additional investigation on claims • Assigning investigative fieldwork to third-party vendors and overseeing vendor performance, quality, and compliance • Completing and/or contributing state-level SIU statistical reporting functions in conjunction with compliance department personnel • Providing consultative support to claims staff regarding fraud detection, subrogation, and recovery opportunities • Reviewing vendor investigative findings and preparing or validating reports summarizing conclusions and recommendations • Coordinating with legal, compliance, underwriting, and law enforcement/regulatory agencies when necessary • Developing and facilitating training and awareness initiatives to strengthen fraud prevention capabilities across the claims team • Seeking out new vendors with insightful data sources and technology solutions that help identify fraud or questionable claim indicators • Performing other duties as assigned.

🎯 Requisitos

• 10+ years of commercial insurance claims experience, including direct handling of litigation caseloads • 3+ years of leadership experience preferred • Strong background in claims handling, fraud detection, and subrogation with proven ability to evaluate complex claims • Strong knowledge of Claims investigation laws and regulations • Bachelor's degree (or equivalent experience) • Demonstrated proficiency in current fraud analytics, technology and investigative tools (e.g., ISO, Carpe Data, or similar) • Knowledge of SIU regulatory requirements and state-level statistical reporting obligations • Experience managing or coordinating third-party investigative vendors • Excellent analytical, critical thinking, and problem-solving skills • Strong communication and collaboration skills, including ability to influence decision-making across claims teams.

🏖️ Benefícios

• health and welfare benefits • tuition and professional certification assistance • 401k savings • elective participation in the Employee Stock Purchase Program • paid time off • paid holidays • child bonding leave • other employee assistance