Claims Service Representative 3 - Special Investigations Unit

AAA Auto Club Enterprises; Lincoln (RI); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health coverage: medical, dental, and–

401(k) with company match and pension

Tuition assistance

Floating holidays and PTO for charity

Paid parental leave

Wellness programs

Employee discounts

Job summary

AAA Auto Club Enterprises in the United States is seeking a claims fraud investigator to oversee the investigation and disposition of potentially fraudulent claims across product lines. The role also serves as a liaison to industry bodies such as NICB and the Department of Insurance, requiring public speaking, teaching, and reporting capabilities.

The position involves developing investigative strategies, supervising field work, preparing clear investigative reports, and providing training to

Qualifications

• Bachelor's equivalent combination of education and experience.
• 4-6 years prior Claims experience.
• Moderate computer and line of business technical software skills.
• Advanced application of policy language as applied to coverage, liability, and settlement.
• Advanced organization and planning recognition skills.
• Advanced oral and written communication skills.
• Advanced interpersonal skills.
• Advanced interviewing and negotiation skills.
• Valid Driver's License, acceptable DMV record and minimum liability insurance - issued by state required.

Responsibilities

• Develop and implement investigative strategies for assigned casualty, auto property damage, auto theft, and/or homeowners claims.
• Complete and/or supervise thorough field investigations to ensure proper coverage is afforded.
• Includes reviewing and investigating suspicious activity, using effective investigation strategies, and background searches and research as appropriate.
• Prepare and provide investigative reports clearly outlining the issues, investigation, findings and recommendations to claims staff.
• Ensure proper reporting to NICB, Department of Insurance, and local District Attorneys, as warranted; attend and/or testify in court hearings and proceedings as required.
• Remain current on emerging fraud trends, investigations, and fraud identifying/combatting tools.
• Provide training to claims staff on insurance fraud and industry trends.
• Liaise with assigned claims teams to educate anti-fraud personnel to identify, articulate, and refer suspicious claims.
• The position requires discretion and independent judgment in analysis, problem solving, and time management to effectively manage investigations.

Skills

Oral communication

Written communication

Interpersonal skills

Negotiation

Interviewing

Organization

Planning

Computer skills

Policy language

Education

Bachelor's equivalent

Job description

Job Summary

This position's primary responsibility is the investigation and disposition of potentially fraudulent claims in any product line sold by the organization. The position also acts as liaison between the organization and industry entities, which include other carriers, law enforcement, District Attorneys, NICB and the Department of Insurance. The position requires a diverse skill set which includes investigating, public speaking, teaching and reporting.

Job Summary

This position's primary responsibility is the investigation and disposition of potentially fraudulent claims in any product line sold by the organization. The position also acts as liaison between the organization and industry entities, which include other carriers, law enforcement, District Attorneys, NICB and the Department of Insurance. The position requires a diverse skill set which includes investigating, public speaking, teaching and reporting.

Job Duties

• Develop and implement investigative strategies for assigned casualty, auto property damage, auto theft, and/or homeowners claims. Complete and/or supervise thorough field investigations to ensure proper coverage is afforded. Includes reviewing and investigating suspicious activity, using effective investigation strategies, and background searches and research as appropriate.
• Prepare and provide appropriate investigative reports clearly outlining the issues, investigation, and findings and recommendations to claims staff.
• Ensure proper reporting to NICB, Department of Insurance, and local District Attorneys, as warranted. Includes attending and/or testifying in court hearings and proceedings as required.
• Remain current on emerging fraud trends, investigations, and fraud identifying/combatting tools.
• Provide training to claims staff on insurance fraud and industry trends. Liaise with assigned claims teams to educate integral anti-fraud personnel to identify, articulate, and refer suspicious claims.
• The position requires a higher degree of discretion and independent judgment in analysis, problem solving, and time management to effectively manage investigations.

Qualifications

• Bachelors Equivalent combination of education and experience
• 4-6 years 4-6 Years prior Claims experience
• Moderate computer and line of business technical software skills required.
• Advanced application of policy language as applied to coverage, liability, and settlement
• Advanced organization and planning recognition skills required.
• Advanced oral and written communication skills required.
• Advanced interpersonal skills required.
• Advanced interviewing and negotiation skills required.
• Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required

Travel Requirements

• Claims field duties may involve driving and local travel to canvas scenes and interview witnesses. (20% proficiency)

Remarkable benefits

• Health coverage for medical, dental, vision
• 401(K) saving plans with company match AND Pension
• Tuition assistance
• Floating holidays and PTO for community volunteer programs
• Paid parental leave
• Wellness programs
• Employee discounts (membership, insurance, travel, entertainment, services and more!)

Auto Club Enterprises is the largest club within the national AAA federation. We have nearly 17,000 employees in 24 states helping more than 18 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity – we win. All of Us! With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.

"Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”

AAA is an Equal Opportunity Employer

Our organization participates in E-Verify