At EMC, you'll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company's success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees.
**This position is eligible to work from home anywhere in the United States**
Essential Functions:
- Reviews and ensures assignment of referrals to the appropriate investigator based on referral volume, referral type and investigator experience
- Regularly examines investigative files to determine if proper reporting requirements, investigation, evaluation, recommendation, communication techniques and procedures are being followed in accordance with best practices and statutory requirements
- Monitors consistency, quality and outcome of investigations
- Performs quality control on complex litigated referrals regarding communication and correspondence with defense counsel, attorney general or any law enforcement agency
- Provides guidance to team on questions of insurance contracts, investigative process and procedures for organized ring activity, medical terminology, the legal system and strategy
- Ensures that files contain proper and adequate documentation of all activities including reporting requirements, recommendations for further handling and case summaries
- Ensures appropriate use of all database search methods
- Determines if opportunities for recovery or restitution have been identified and pursued
- Oversees and monitors the workload and performance of the team
- Guides team through complex work issues and answers questions
- Collaborates with team members to establish performance goals and monitors status
- Conducts reviews and provides coaching
- Interviews, hires, and recommends salary adjustments for team members
- Resolves disciplinary issues, reviews results, actions plans, and progress
- Provides training for team and encourages continuing education
- Develops team expertise and assists with succession planning, including identifying talent and implementing development plans for critical positions
- Supports diversity, equity, and inclusion initiatives.
- Fosters an innovative culture, including supporting new ideas and providing guidance on potential changes
- Conduct monthly impact review on closed investigative files
- Leads the development of internal and external anti-fraud training, including review of indicators and fraud awareness programs
- Communicates with EMC team members regarding the SIU program and procedural process in handling various types of fraud in specific venues
- Directs technical assistance and recommendations to EMC team members
- Provides internal and external anti-fraud training to customers through investigative discussions, dissemination of educational materials and training meetings
- Collaborates with team members in developing marketing strategies for the SIU department and its services
- Implements assigned marketing strategies and delegates tasks within project teams
- Participates in the establishment of effective policy standards, practices, techniques and procedures for the investigation, evaluation and disposition of the SIU referral. Recommends improvements to department practices through fraud detection techniques, procedures, analysis and prosecution trends. Maintains active involvement in professional associations within the industry.
Education & Experience:
- Bachelor’s degree in business, insurance, criminal justice or related field or equivalent relevant experience
- Eight years of experience in claims adjusting or investigation or related experience
- Prior property and casualty experience
- Fraud Claim Law Specialist (FCLS) designation within the first year of hire
- Insurance designations, such as INS and AIC, preferred
Knowledge, Skills & Abilities:
- Excellent knowledge of property and casualty insurance industry and fraud awareness
- Strong knowledge of the investigative process, including proper identification and collection of physical evidence
- Thorough knowledge of civil and criminal investigative procedures and the legal system
- Excellent knowledge of various statement taking techniques, collection and analysis of public and private records
- Superior investigative skills and ability to make sound decisions
- Strong leadership abilities
- Excellent conflict resolution, negotiation and facilitation abilities
- Demonstrated problem-solving abilities
- Excellent verbal and written communication skills
- Good knowledge of computers and Microsoft Office Suite
- Attendance of the National Insurance Crime Bureau SIU Academy within the first two years of hire
- Occasional travel; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving
Per the Colorado Equal Pay for Equal Work Act, the hiring range for this position for Colorado-based team members is $97,416.51 - $125,099.76. The hiring range for other locations may vary.
Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.
All of our locations are tobacco free including in company vehicles.
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What We Do
EMC Insurance Companies is among the top 60 insurance organizations in the country based on net written premium, and we have more than 2,500 employees. The company was organized in 1911 to write workers’ compensation protection in Iowa. Today, EMC provides property and casualty insurance products and services throughout the United States and writes reinsurance contracts worldwide. Operating under the trade name EMC Insurance Companies, Employers Mutual Casualty Company and one or more of its affiliated companies is licensed in all 50 states and the District of Columbia.
