Job Responsibilities

• Evaluates the risk of referrals to determine if it should be assigned for further investigation by leveraging the specialist’s education, experience, available evidence, and data from information systems to develop an initial assessment of the referral and initiate the investigative process if necessary.
• Reviews referrals and makes a timely and accurate routing decision to the most appropriate personnel based on resource availability, geography, specialty, lines of business and legal requirements. Analyzes and documents referrals sent regarding potential fraudulent insurance policies, claims, distributions, or financial risk activities.
• Investigate possible causes of loss using a variety of programs and online tools
• Compose investigation reports and advise claims staff and management of findings and further recommended action
• Works effectively as part of a regional dynamic team including taking on unfamiliar/difficult tasks when necessary.
• Communicates effectively with different business areas to ensure clear and consistent processes.
• Supports a long lasting, effective team environment, to achieve mutual team and business goals.
• Maintains appropriate level of liaison with internal and external business partners.
• Performs other duties as assigned.

• 3 -5 years of prior experience in data analytics and social network analytics combined with an understanding of insurance
• Post-secondary education in Criminology is preferred.  A combination of education and experience will be considered.
• Strong working knowledge of computer databases, electronic spreadsheets, desktop publishing, word processing and statistical applications to manipulate, analyze data.
• Strong researching skills both internally and externally.
• Strong working knowledge of identifying fraud patterns.
• Ability to maintain strict confidentiality when working with sensitive information.
• Ability to perform well under pressure, while effectively adapting behavior to changing environments.
• Ability to make informed decisions based off a range of information to facilitate a prompt action to maintain service level agreements with business units and customers
• Ability to build, establish and maintain strong relationships both inside and outside the organization.
• Strong analytical and problem-solving skills with the ability to identify relationships, problems and issues
• Prior working experience in related field a definite asset