Manager, Special Investigations – Recovery

🕒 il y a 6 jours

Postuler Maintenant

Trouver des Emplois à Distance Similaires

Recevoir des emails pour des emplois à distance

📊 Vérifiez votre score de CV pour ce poste

Améliorez vos chances d'obtenir un entretien en vérifiant votre score de CV avant de postuler.

Télécharger le CV

Skyward Specialty Insurance

Site WebLinkedInTous les Emplois

501 - 1000 employés

Fondée en 2007

🤝 B2B

💸 Finance

⚕️ Assurance santé

💰 €177 300 000 Post-IPO Secondary - Skyward Specialty en 2024-05

B2B • Finance • Healthcare Insurance

Skyward Specialty Insurance est un groupe d'assurance spécialisé basé à Houston, qui propose des solutions de gestion des risques sur mesure dans des marchés de niche et complexes. L'entreprise offre une gamme de produits d'assurance spécialisés, y compris l'Excess & Surplus (E&S) transactionnel, les lignes professionnelles, l'excédent de perte médical, la caution, les captives, des programmes, des biens mondiaux, l'agriculture et le crédit (ré)assurance, ainsi que du conseil en gestion des risques. Skyward travaille principalement avec des courtiers et agents, tire parti de la technologie (y compris les capacités d'e-surety) pour offrir des services de souscription et de gestion des sinistres innovants, et se concentre sur des risques très complexes, non standards et des solutions spécialisées évolutives.

Description

• 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.

🎯 Exigences

• 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.

🏖️ Avantages

• 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