Investigates components of claims, premium avoidance, and collections submitted to Chesapeake Employers by means of developing factual information to ensure the propriety of claims benefits, or assists in case development for legal actions in instances of impropriety.
Duties and Responsibilities:
- Manage and control all activity involving investigative cases assigned for premium avoidance, collections, or claims.
- Investigate suspected/reported incidents of fraudulent activity/premium avoidance on the part of claimants, policyholders, vendors, and agents and/or any other individual/entity conducting business with Chesapeake Employers by obtaining and reviewing documents and other information for completing a Premium Avoidance Audit/Claims Investigation.
- Independently examine and evaluate internal documentation for validation and decision making on claims, underwriting or premium avoidance files.
- Independently formulate and implement adaptive investigation action and payment plans through the course of a claim, fraud, or premium avoidance file’s life.
- Conduct professional interviews of investigation targets, victims and witnesses.
- Independently review and evaluate financial documents pertaining to active case files.
- Independently review and evaluate court documents pertaining to active case files.
- Testify in court as an expert witness on active case files.
- Act as Professional liaison with Chesapeake Employers’ business partners, other insurance carriers, lawenforcement, and state administrative agencies as pertains to active investigations.
- Conduct training in the capacity of an expert in fraud examination.
Skills, Education and Experience:
- Bachelor’s Degree required
- 2-4 years experience in workers compensation insurance
- Proficient in Microsoft office products.
- Basic PC skills required. Knowledge of data base research.
- Ability to work in a fast-paced, time sensitive, quality driven environment.
- Valid driver's license with good driving record.
- Bias for Action
- Knowledge Sharing
- Deliver Results
- Service and Sales Excellence
- Personal Leadership
- Teamwork and Communication
While performing the duties of this job, the employee is regularly required to sit, use hands to finger, handle or feel objects, tools or controls; reach with hands and arms. The employee is occasionally required to stand, walk, stoop, kneel, crouch or crawl. The employee may occasionally lift up to 30 pounds. Specific vision abilities are required which include, close vision, peripheral vision and the ability to adjust focus.
Office Environment. The noise level is usually moderate. Some travel is required.
Job Type: Full-time
Pay: $57,075.00 – $71,344.00 per year
- Dental insurance
- Disability insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Tuition reimbursement
- Vision insurance
- 8 hour shift
- Monday to Friday
- One location
- Only full-time employees eligible
- Remote interview process
- Personal protective equipment provided or required
- Temperature screenings
- Social distancing guidelines in place
- Virtual meetings
- Sanitizing, disinfecting, or cleaning procedures in place