GENERAL PURPOSE OF THE JOB:

The Fraud Investigator I is primarily responsible for investigating fraud and fraud related matters. The role is also responsible for assisting in the resolution of consumer and/or insurance department inquiries and/or complaints in a timely manner.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Researches assigned fraud cases, investigating, resolving and/or responding to cases using various resources including documentation, database systems, logs, etc. and may be involved with the following depending on the case:
  • Researches processes that created the complaint such as new business application entry, suitability review, and delivery of contract.
  • Communicates with necessary internal and external customers to assist in the investigation process.
  • Assists/resources for compliance and other departments.
  • Analyzes and produces information for case review.
  • Pulls calls on a per case needed basis and review.
• Assists with on-going company fraud training and participates in fraud webinars.
• Analyzes and resolves complaints using problem solving techniques and creative solutions for a fair outcome as needed.
• Takes complaint calls and or emails and follows through with appropriate persons/departments.
• Provides guidance to fellow team members.
• Participates in industry organizations and conferences.
• Manages and updates applicable reports.
• Performs other duties as assigned.

SUPERVISORY RESPONSIBILITIES: NA

Direct Reports: 0

General Description of Indirect Reports (2 and 3-downs): 0

EDUCATION AND/OR EXPERIENCE:

Associates degree and experience in customer service or quality assurance related role. ; or equivalent combination of education and experience.

• Experience performing fraud investigations preferred.

CERTIFICATES, LICENSES, PROFESSIONAL DESIGNATIONS:

Certified Fraud Examiner (CFE) designation preferred.

KNOWLEDGE, SKILLS AND ABILITIES:

• Effective verbal and written communication skills.
• Strong customer service orientation.
• Mathematical skills and strong attention to detail.
• Ability to work cooperatively and successfully with co-employees, customers, and other outside third parties.
• Strong organizational and planning skills.
• Ability to read, analyze, and interpret general business periodicals, professional journals and technical/operational procedures.
• Investigative, research and analytical skills.
• Ability to successfully handle pressure and meet deadlines in a fast-paced work environment.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Proficient in the use of Microsoft Office Suite.