Job Description

We are seeking a qualified Triage Analyst-Intermediate candidate whose primary focus is to combat insurance fraud using fraud analytics software. Join the SIU unit where you will put your investigative experience in the property claims to help identify and prepare suspicious claims and/or insurance applications for further investigation by conducting advanced research and providing investigative handling guidance to others. The ideal candidate has investigative experience specific to property insurance claims, methods of investigation, and an ability to work autonomously as an integral part of our results-driven Special Investigative Unit.

POSITION SUMMARY:

This position’s primary purpose is leveraging robust analytic systems, and knowledge of insurance fraud, assist with the design, implementation, monitoring and performance tracking of Fraud detection models helpful in detecting fraud that impacts the insurance operation and provide technical guidance on suspicious policies and claims investigated within the Special Investigations Unit (SIU).

ESSENTIAL FUNCTIONS:

Models ethical behavior and executes job responsibilities in accordance with Citizens core values, ethics, and information protection policies.

• Leverages complex analytic systems and insurance knowledge to analyze data and identify suspicious policies and claims; conducts moderate to complex forensic research. Conducts research on the exposure to identify trends, potentially fraudulent conduct, and expose organized ring activity.
• Uses independent judgement to plan, prioritize, respond to high-risk alerts, and determine the need for additional fact gathering. Provides consultative guidance on investigative strategies to individual contributors and managers within the insurance enterprise to resolve high-risk exposures.
• Creates and designs innovative and cutting-edge predictive models consisting of business rules, third party sources, and the critical components key to the business unit’s mission to expose suspect patterns and associations; monitors model performance and adjusts models.
• Assist with the implementation of new processes and software solutions, identify system improvements to prevent fraudulent activities and maintain fraud analysis models to improve efficiency and effectiveness of the predictive systems.
• Coaches, advises, counsels, and trains insurance staff; may also direct the work activities of others, provide input in the Performance Management goal setting and review process.

Qualifications

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:

• High degree of knowledge and skills related to the investigation and defense of property claims.
• Demonstrated knowledge of the SIU investigation processes and methodologies.
• Ability to communicate effectively verbally and in writing with a wide range of staff and management.
• Proficiency with fraud detection software and tools.
• Ability to work independently with minimal supervision and manage a high volume of assignments.
• Ability to resolve conflicts and create rapport with business partners.
• Identify and resolve issues and identify solutions, utilizing comprehensive analytical skills and demonstrating an attention to detail.
• Prior experience with risk analysis, risk management.
• Strong organizational and time management skills / Self Motivated.
• Strong customer service skills and ability to build relationships and collaborate with internal and external stakeholders.
• Strong Microsoft Office Suite skills.
• Analytical skills and ability to make decisions; logical and sequential thinker.

REQUIRED EDUCATION AND EXPERIENCE:

• High School Diploma or Equivalent.
• Bachelor’s Degree OR 3 years relevant experience, OR a combination of college education and relevant experience equivalent to 3 years.

AND

• 4 or more years of combined SIU/investigative experience and/or property/casualty experience.

Additional education may count towards experience

PREFERRED QUALIFICATIONS:

• 5 or more years of investigations / SIU experience in the P&C Insurance industry.

• Investigation experience with established workflows and hands on reviewing the claims files.

• Knowledge of Fraud Analytics Software and or Fraud detection methodologies.

• Demonstrated broad problem-solving skills.

SCOPE/COMPLEXITY OF WORK:

Percentage of time accountable for short-term operational goals: 30%

Percentage of time is accountable for transactional, day to day operational support: 70%

PHYSICAL REQUIREMENTS:

Frequent : Stationary position; Operate, Activate, Use, Prepare, Inspect, Place, Detect, Position.

Occasional : Move, Traverse; Ascend/Descend, Work Atop, Traverse; Position self (to), Move; Travel; May participate in catastrophe response, including deployment to remote offices and/or extended hours for extended periods of time.

Continuous : Communicate, Detect, Converse with, Discern, Convey, Express oneself, Exchange information; Detect, Determine, Perceive, Identify, Recognize, Judge, Observe, Inspect, Estimate, Assess.

_ Selected candidates must live within a commutable distance (approximately 50 miles) to Citizens Jacksonville, FL office location._

Additional Information

We offer unlimited career potential, excellent training and development opportunities, and a structured Career Development program to explore future roles of interest while growing and developing in your existing role.

Citizens offers a competitive compensation and benefits package that includes comprehensive medical/dental, Retirement Savings Plan, Vacation and Sick Time, EAP, Tuition Reimbursement, Community Service and much more!

· Retirement savings plan with a generous company match

· Medical, dental and vision coverage

· Company Paid employee basic life insurance and short-term disability

· Generous paid time off: vacation, sick and holiday leave

· Employee Assistance and Wellness Programs

· Tuition reimbursement

· Professional and leadership development opportunities

· Flexible work schedule and Alternative Work Arrangements

· Company Paid Parking

· Employee recognition programs

· Relocation assistance (where applicable)

· Community and volunteering opportunities

· Casual dress

Citizens is Proud to Be an Equal Opportunity Employer

Visa sponsorship is not available for this position.