Claims SIU Analyst

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Job Summary

Arch is currently recruiting for an Analyst to join our Special Investigations Unit (SIU).  This individual must have investigative skills to independently conduct aspects of fraud review, anti-fraud compliance audits as well as other insurance related investigations.

Under technical direction, outline a game plan for assignment objectives and appropriately document and communicate to clients and the SIU Director.  Works within specific limits of authority on assignments requiring moderate technical complexity and coordination.  Utilizing SIU guidelines and policies, reviews referrals to ensure proper documentation received, determines if an investigation will be pursued and handle to resolution.

Essential Duties & Responsibilities

Performs a combination of duties in accordance with departmental guidelines:

Complete proper ISO searches to summarize and make recommendations on loss history. Determine if tasks can be completed internally or require the use of a vendor and make the referral if warranted.  These referrals include background checks, surveillance, and AOE/COE investigative assignments. Become aware of the best vendor to use for a given circumstance or jurisdiction Complete State Fraud Referral request forms with all required data for the specified jurisdiction including:  claim summary, red flag indicators, investigation summaries, all parties involved, litigation summary and claim status or disposition. Navigate through several different TPA/MGA claim systems to retrieve information for ISO searches, SFRs, case referrals to vendors and to obtain claim and policy information. Assist SIU Director with projects, reconciliations, writing audit result reports and handling routine/daily matters in their absence. Triage incoming new referrals to SIU to set objectives and determine if internal handling or vendor utilization is necessary. Build relationships with SIU vendors and determine which are most effective in results and cost.

Skills, Knowledge & Abilities

• Solid knowledge of claims and insurance theory and practices
• . Demonstrated technical expertise, product specific knowledge, and negotiation skills.
• Strong interpersonal and communication skills. Ability to effectively interact with all levels of Arch’s internal and external business partners.
• Ability to work independently.
• Strong analytical and problem-solving skills.
• The ability to exercise independent judgment and make critical business decisions effectively.
• Knowledge of Microsoft Office Suite as well as other business-related software.

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#LI-REMOTE

For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible.

$53,300 - $66,600/year

• Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future.

Click here to learn more on available benefits.

Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn’t the right fit but you’re interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch’s Talent Acquisition team.

14400 Arch Insurance Group Inc.