Investigator, Fraud Operations

Job description

Position Overview

The Investigator, Fraud Operations undertakes the review and analysis of referrals for questionable claims, policy, supplier, and other potential fraud issues to determine whether investigation is required and the subsequent assignment of an investigator.  

This individual will utilize various methods, including technology tools, and investigative resources to validate the potential fraud issues or concerns.

The role also has responsibility for the daily handling of incoming items via the Fraud Information Centre, and the Terrorist and Sanctioned Parties screening.

Accountabilities

·  Evaluate referrals from internal and external sources  to determine questionable claim, policy, and supplier issues requiring investigation  
·  Decide if an investigation is warranted
·  Prioritize assignments based on fraud management accountability, and  case prioritization guidelines to determine resource availability, reputational impact to company, and deterrent impact
·  Provide feedback and/or coaching to referrers on quality of referral, and awareness of potential fraud
·  Send appropriate alert notifications and investigation assignments based on findings
·  Initial intake of tips and creation of tip record in case management system
·  Undertake telephone interviews/statements from tipsters
·  Handle emergency and after hours email and telephone fraud referrals
·  Undertake Terrorist and Sanctioned Parties screening
·  Review and action of requests for investigative assistance/tasks
·  Participation in investigation or project investigations as assigned
·  Assist other investigators with additional data required over the course of the investigation or follow up on leads submitted though investigators
·  Liaise with Fraud Management or other investigative team colleagues, and the Claim, Underwriting, and Legal operations

Required Knowledge, Skills & Experience

·  Post-secondary education
·  CIP designation or working towards CIP
·  Minimum 5 years working in claims or underwriting capacity within an insurance company.  Strong technical knowledge specific to claims line of business.  Investigative or litigation background.
·  Bilingualism in English and French would be considered a strong asset
·  Strong understanding of claims and underwriting processes
·  Superior analytical, problem-solving and decision-making skills
·  Strong customer service and communication skills – ability to communicate diplomatically and empathetically
·  Strong verbal and written communication skills, including presentation skills
·  Assertive and comfortable with challenge and ambiguity
·  Investigative competency
·  Technical knowledge of all insurance lines of business, including policies, claims, and related legislation
·  Investigative strategies and requirements/legislation
·  Ability to make confident and objective decisions in matters having high potential for legal precedent or legal dispute
·  Ability to source, understand, and analyse data
·  Ability to maintain confidential information
·  Strong knowledge of systems or understanding of various platforms used within the industry
·  Rotational shared responsibility for 24/7 on-call availability for handling of after-hours email and telephone fraud referrals (Fraud Information Centre)
·  Ability to work evenings or weekends, as required

Aviva Canada is committed to providing accommodations for people with disabilities during all phases of the hiring process including the application process. If you require an accommodation because of a disability, we will work with you to meet your needs. Applicants need to make their needs known in advance. If you are selected for an interview and require an accommodation, you are encouraged to advise the Talent Acquisition Partner who will consult with you to determine an appropriate accommodation.