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Florida Claim Investigator Jobs

Company

AAA The Auto Club Group

Address , Remote
Employment type FULL_TIME
Salary $67,000 - $80,000 a year
Expires 2023-07-16
Posted at 1 year ago
Job Description
It’s a great time to join AAA The Auto Club Group!
JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD
Job Type:
Full time

Exempt/Non Exempt:

Salary
:

Florida Claim Investigator – The Auto Club Group
What you will do:
The Auto Club Group is seeking a prospective Claim Investigator who will independently perform comprehensive assessment and investigation of personal lines property & casualty claims for the potential of claim fraud.
In this position, you will have the opportunity to:
  • Prepare written investigative summaries, and report findings to the assigned claim handler, management, Underwriters, and others.
  • Investigative activities may also involve hiring experts for specialized tasks such as home fire cause and origin analysis, surveillance, vehicle accident reconstruction, forensic accounting, and legal counsel, and managing those vendors through setting clear expectations, monitoring results, and reviewing and paying associated expenses.
  • Contact the claim representative assigned to the claim, work with them collaboratively, and keep them informed throughout the claim investigation.
  • Work collaboratively with law enforcement, other insurance carrier special investigation units, attorneys, and other parties.
  • Thoroughly document investigative activities, results, and evidence.
  • Understand and assess the implications of laws, licensing and practices related to those professions and their applicability to identifying and defending against policy and claim fraud.
  • Research and investigate fraud collaborators, fraud rings, and potentially fraudulent service businesses and professionals such as medical providers, body shops, attorneys or contractors.
  • Obtain and follow-up on public records, as well as police, fire and other official reports. Complete link analysis to understand the relationships between people, places, and things.
  • Obtain legal counsel opinion when necessary.
  • Maintain a comprehensive understanding of claim fraud, including the fraud scenarios and methods by which insureds, claimants, service providers, and other parties may engage in opportunistic fraud, and also the ways in which businesses, professionals and organized crime groups, such as fraud rings, operate.
  • Review claims to identify the potential fraud scenarios that might be present, both for claim fraud and also policy premium fraud.
  • Complete vehicle inspections, home inspections, or conduct site-visits.
  • Attend court hearings when necessary.
  • Investigative activities may include identifying insureds, claimants, witnesses, service providers, and other parties and completing interviews or recorded statements.
  • Obtain customer records such as utility bills and other documents pertinent to the investigation and when necessary, with the permission of the insured.
  • Maintain a thorough understanding of insurance policies and claim handling practices and procedures, as well as insurance policy eligibility and underwriting requirements.
  • Complete investigative activities that will help prove or disprove the presence of fraud.
  • Understand and comply with state laws, regulations, and case law impacting claim fraud and investigation activities.
  • Arrange for and attend Examinations Under Oaths.
  • Promote fraud awareness and expertise through liaison, consulting, collaboration, and training of company personnel when assigned.
  • Complete investigations thoroughly but also balance expense costs against the facts and exposure of the claim.
With our powerful brand and the mentoring, we offer, you will find your position as a Claim Investigator can lead to a rewarding career at our growing organization.
How you will benefit:
Our Auto Club Group Claim Investigator earns a competitive salary of $67,000 - $80,000 to start along with the opportunity for an annual company bonus incentive.
  • Vision
  • Paid Holidays
  • Dental
  • Tuition Reimbursement
  • Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include:
    • 401k Match
    • Medical
    • Dental
    • Vision
    • PTO
    • Paid Holidays
    • Tuition Reimbursement
  • PTO
  • Medical
  • 401k Match
We’re looking for candidates who:
Education:
  • College level coursework in Business Administration, Insurance, Criminology or a related field or the equivalent in related work experience. Bachelor’s degree preferred.
  • Fraud Claim Law Specialist Certification, preferred.
  • Bachelor’s degree in Business Administration, Insurance, Criminology or a related field or the equivalent in related work experience
  • Certified Insurance Fraud Investigator Certification, preferred.
  • Completion of The Institutes Associates in Claims (AIC), Chartered Property Casualty Underwriter (CPCU), or other insurance coursework.
  • Possession of a valid State Driver's License.
Experience:
Work experience including one of the following:
  • Five years of experience as a claim representative handling Auto or Home personal lines property and casualty insurance claims.
  • Work experience in both claims handling as well as fraud investigation.
  • Five years in law enforcement in roles such as detective, auto theft investigator, or arson investigator.
  • Three years as an investigator in a claims special investigation unit that investigates fraud in personal lines property & casualty claims.
Knowledge of at least one of the following:
  • Auto and Home policy coverages, provisions, and eligibility and underwriting rules
  • Medical injury treatment and medical provider practices as they relate to automobile accidents.
  • Vehicle construction, repair estimation, repair, and body shop industry practices
  • Laws and regulations pertaining to insurance, claim handling, crime, and investigative activity.
  • Fraud investigation techniques and practices
  • Home construction, repair estimation, repair, and contractor industry practices
  • Claim fraud scenarios and indicators.
  • Claim handling practices.
Ability to perform the following:
  • Process complex, time sensitive data and information from various sources
  • Impart fraud awareness training in a formal or informal setting to other ACG employees, community groups or related professional organizations.
  • Prepare and present effective written reports (a written sample may be required at time of interview)
  • Safely operate a motor vehicle
  • Engage and manage experts to complete specialized tasks.
  • Communicate effectively with others in a work environment and with the public (e.g. Police department, vendors, contractors, attorneys, other insurance carrier special investigation units)
  • Maintain and continually expend expert knowledge on claim fraud scenarios and indicators.
  • Complete multiple complex tasks in a timely fashion and under deadline pressure while working on multiple cases simultaneously.
  • Analyze policies and claims for relevant provisions and applicability to the claim facts.
  • Investigate claims, define appropriate evidence, and obtain supportive documentation.
  • Present effective and persuasive testimony in civil and criminal litigation on a regular basis
  • Function effectively and independently in a personal computer environment utilizing word processing, spreadsheet, and software systems.
Work Environment
This is a hybrid work arrangement (time spent in office and remote). Depending on the employee's role and leadership's assessment, some employees will come in to an ACG facility on a weekly basis, a monthly basis, or on an "as needed" basis for key meetings and collaborative activities. Most employees will be required to come into the office, at a minimum, for important departmental meetings or teambuilding events.
Who We Are
Become a part of something bigger.
The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.
By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life’s journey through insurance, travel, financial services, and roadside assistance.
And when you join our team, one of the first things you’ll notice is that same, whole-hearted, enthusiastic advocacy for each other.
We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.
To learn more about AAA The Auto Club Group visit
www.aaa.com
Important Note:
ACG’s Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.
The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.
The Auto Club Group, and all its affiliated companies, is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
Regular and reliable attendance is essential for the function of this job.