Consultant, Major Case SIU
Location: , Minnesota
Description: Nationwide Mutual Insurance Company is in need of Consultant, Major Case SIU right now, this occupation will be assigned in Minnesota. More complete informations about this occupation opportunity kindly read the description below. This is a work from home position and the ideal candidate will reside in the greater Minneapolis / St. Paul area. We are looking for an individual with extensive SIU inv! estigator experience and this position will have a heavy focus on medical fraud.
JOB SUMMARY: Serves as an investigative consultant, investigator and process leader for Major Case investigations. Reviews and makes recommendations on outcomes of investigations in a prompt and expeditious manner. Provides guidance and recommendations to claims leadership and associates on claims resolution. Promotes and provides "On Your Side" customer service. May also function in a support role to an SIU Director for product line performance and strategy support.
RELATIONSHIP: Reports to Reports to Claims Manager/Director
DIRECT REPORTS: None
JOB RESPONSIBILITIES:
1. Completes investigative activities and or advanced research activities on assigned cases in accordance to SIU and Major Case Best Practices.
2. May act as primary investigator on assigned major case and provide direction to Special Investigation team members and! P&C staff areas.
3. Provides reserve analysis to ens! ure timely and accurate case reserves in accordance with Best Claims Practices.
4. Maintains current knowledge of: assigned insurance lines; court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars or training session.
5. Serves as a SIU investigative consultant on assigned Major Case investigations, i.e., organized insurance fraud.
6. Submits expense reports and other administrative reports as required and maintains assigned company equipment.
7. Leads special projects and special operations that support the Major Case strategic initiatives.
8. Represents Nationwide by testifying in civil court proceedings as needed.
9. Responsible for assisting with managing the SIU processes for consistency within a specialty, regardless of geographic location. Coordinates efforts with other SIU field an! d or P&C staff areas.
10. Assists with managing outside counsel regarding open claims investigations and recovery (subrogation) efforts on paid claims.
11. Provides guidance and recommendations to leadership on claims resolution.
12. Responsible for driving select critical activities directly related to assigned function or program.
13. Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective Nationwide customers.
14. Assists SIU Director with driving productivity and or performance for a product line such as casualty, material damage, property or area¿s of the company that lack an investigative arm to resolve complex fraud issues.
15. Performs all other duties as assigned
JOB REQUIREMENTS:
Education: Undergraduate degree or equivalent experience in insurance, law, sociology, criminal justice or business preferred.
Licenses/Designations:! State licensing where required. Successful completion of required ! claims certification schools/classes. Fraud Claims Law Specialist or Certified Insurance Fraud Investigator designation highly desirable.
Experience: Eight years related experience in SIU claims. Prefer exposure to vendor management, claims quality /audit processes and/or field SIU operations.
Knowledge: Knowledge of SIU operations and processes claims handling, insurance contract and legal issues, and fraud investigation techniques. Preferred experience with multistate laws, regulations and civil recovery. Knowledge of claims business operations including claims process, procedures, best practices, and service levels as well as investigation techniques. Must possess knowledge of Property/Casualty Insurance, such as organization, structure, channels, and business focus for the Special Investigation Unit organization and company. Demonstrated knowledge of current investigative trends and awareness of potential developments impacting Special Investigatio! n Unit. Comprehensive knowledge of State Fraud Statutes and Policy contracts across all businesses (e.g. Property, Casualty, Commercial)
Skills/Competencies: Oral and written communication skills for interaction with vendors, field SIU associates, SIU management, and other areas of claims; negotiation skills for vendor management, program management and/or claims quality calibration. Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience.Proven analytical skills to make independent decisions and resolve conflict in such areas as application of coverage to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions. Proven ability to coordinate defense counsel in the handling of cases involving serious and sometimes complex liability and damage issues from inception through trial. Proven oral and wr! itten communication skills for use in communicating with policyholders,! claimants, attorneys, physicians and all levels of management. Proven organizational skills to effectively establish work priorities in conformity with objectives and standards. Proven ability to operate personal computer with proficient use of claims and business software.
Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.
Staffing Exceptions to the above Minimum Job Requirements must be approved by: Business Unit Executive and Human Resources.
JOB CONDITIONS:
Working Conditions: Normal office environment or remote work environment. Representatives may be required to operate an automobile and have a valid driver's license with a safe driving record. Must be willing to work extended hours and to travel with possible overnight requirements. Must be available to work catastrophes (CAT) requiring travel to CAT sites with multiple on-site responsibilities and/or for extended periods of tim! e. Including holidays and weekends.
Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
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If you were eligible to this occupation, please give us your resume, with salary requirements and a resume to Nationwide Mutual Insurance Company.
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This occupation will be opened on: Wed, 04 Sep 2013 08:00:41 GMT
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