Individual could work out of any CNA office, but we would prefer to hire a person in our Chicago Home Office. Job Summary: Under technical direction; properly initiates, completes and submits numerous and various state fraud reports, plans, contact forms, acknowledgment letters and state surveys. This employee will also be required to monitor the ever changing state laws governing fraud, codes, and regulations, while working with the Knowledge and Learning Group to assist in the identification, development, oversight and tracking of the mandatory training requirements of the various states. Furthermore, this employee will assist in the coordination review efforts of both internal and external auditing teams.
Essential Duties & Responsibilities: 1. Analyzes and evaluates suspected fraud or arson claims through various internal and external data bases and contact with other Special Investigation Unit personnel, Claim personnel, State Compliance, Regulatory and Investigation Personnel, and other sources as needed. Initiate, prepare, complete, and submit numerous and various state fraud reports, plans, contact forms, acknowledgment letters and state surveys. 2. Work with Knowledge and Learning Group to identify, develop, oversee and track mandatory training requirements of various states. When needed, conduct necessary training sessions. 3. Assist with the coordination review efforts of internal and external auditing teams. Assist in gathering needed documents and information for internal and external audits. 4. Prepares reports for management review. 5. May prepare cases for presentation to local prosecutors for pursuit of criminal actions. May be required to testify on behalf of the company in either civil or criminal cases. 6. Updates claims and proprietary SIU systems. 7. Leads or assists in local branch training to enhance fraud and arson awareness and regulatory compliance. 8. Keeps current on state/territory issues, regulations and trends. 9. Assists claims or defense staff as needed. 10. Participates in community-based fraud/arson associations.
Skills, Knowledge & Abilities Required: 1. Solid knowledge of fraud and arson investigative practices. 2. Solid knowledge of the industry, organization, product specific knowledge as well as insurance claims investigation and surveillance practices and procedures. 3. Knowledge and/or experience with state fraud reporting and state fraud plan requirements 4. Solid interpersonal, verbal and written communication skills. Ability to effectively interact with all internal and external business partners. 5. Ability to work independently. 6. Solid analytical and problem solving skills. 7. The ability to exercise independent judgment and make sound business decisions effectively. 8. Knowledge of Microsoft Office Suite and other business related software systems. 9. Ability to travel.
Education & Experience Required: 1. Bachelor's degree, or equivalent. 2. Five to seven years of fraud or arson investigations experience preferably with some insurance industry experience and experience with civil and criminal cases. 3. Certification in criminal justice and investigations or equivalent professional training. 4. Knowledge of state fraud reporting and state fraud plan requirements. 5. Experience in conducting fraud training desirable. 6. Experience in working with audit teams to obtain and present desired information.
