Claims Fraud and Investigations Manager

Zurich North America is seeking a Claims Fraud and Investigations Manager to support our Zurich Claims Investigative Services.

 

At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when it comes to choosing your next career move. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location, while facilitating in-person connections and collaborative activities when meaningful and valuable. While the model provides a high level of flexibility and autonomy, occasional circumstances requiring in-office attendance should be expected.  This is a fully remote role and can reside anywhere in the United States.

 

The Claims Fraud and Investigations Manager is responsible for managing the daily activities of the Claims Fraud Investigations Team in order to prevent, detect and investigate suspected external fraud against the organization and its customers, to ensure that all claims fraud risks are effectively and efficiently governed and managed.

 

Additional responsibilities may include:

 

• Providing first class and effective Claims Investigation services to Business Unit Claims function and beyond, by delivering high quality and professional investigation reports with decisive conclusions and technically excellent content.
• Providing operational and technical management of teams of investigators and work alongside the Head of Claims Fraud & Investigations in the BU to develop strategy and maximize savings in areas of responsibility.
• Actively monitoring and steer highly complex cases (assigned or escalated to you) that include large loss, multi-claim, complex investigations in commercial lines.
• Handling technical referrals, complaints and work closely with internal audit on Claims Fraud Investigation performance.
• Conducting quarterly quality audits of closed investigations performed by the team, as well as occasional audits/reviews of open files.
• Training the team & Claims Partners in how to identify, investigate and document/report fraudulent claims.
• Serving as day-to-day contact with Business Unit Claims managers to ensure effective execution of fraud investigations.
• Adhering to local regulation and Zurich Claims governance requirements throughout the investigative process to ensure that all information and data is obtained within data protection rules and regulations.
• Collating and analyze accurate fraud data to provide information and Management Information for internal communications in order to support ongoing promotion of, and adherence to the claim’s fraud strategy.
• Acting as the liaison between Claims Fraud Investigation team and Human Resources group on all Human Resources/ personnel issues

 

Basic Qualifications:

 

• Bachelor's degree and 6 or more years of experience in the Insurance Fraud or Insurance Investigations area
   OR

• Zurich Certified Insurance Apprentice, including an Associate Degree and 6 or more years of experience in the Insurance Fraud or Insurance Investigations area
   OR
• High School Diploma or Equivalent and 8 or more years of experience in the Insurance Fraud or Insurance Investigations area in commercial insurance.
  AND
• Leadership experience.
• Project management experience
• Must obtain and retain anti-fraud certification
• Knowledge of commercial claims handling processes and procedures.
• Experience in interpreting and applying state fraud statutes and regulations.

 

Preferred Qualifications

 

• Highly preferred experiences in commercial insurance in one of the following:  Auto, GL, WC, Property, Auto Finance, Transportation (Inland/Ocean), CAT coordination.
• Experience working organizational development projects:  Process improvement & streamlining, Quality assurance development, innovation tech research, review.
• Experience implementing process and procedures, de