Anti-Fraud Manager

Anti-Fraud Manager

Location:

Van Wert, OH;
Dublin, OH;
Waltham, MA;
Alpharetta, GA;
Irving, TX ;
Work Model:
Hybrid or Remote based on location ;
Position type:
Full time - salary

Fraud prevention is at the heart of protecting our customers and our business and that's where this role makes an impact. As Anti-Fraud Manager, you'll lead front‑line investigative efforts, tackle complex and high‑impact cases, and partner with a wide network of internal teams and external agencies. This is an opportunity to shape strategy, develop talent, and bring modern tools and analytics into real‑world fraud detection and deterrence.

Key Responsibilities of the Role

• Supervises the day‑to‑day investigative activity of SIU field/desk investigations and support activities throughout regions.
• Acts as the direct liaison with the various Claims Staff, Departments of Insurance and other regulatory agencies, NICB and other industry investigative representatives.
• Monitors and evaluates the quality of performance and key results through ongoing audits and review of results of both direct adjuster and advanced cutting edge analytic referrals of both artificial intelligence and machine learning.
• Reviews and evaluates all available information to assess the appropriateness of referrals for prosecution and/or recovery.
• Ensures that all SIU investigation files include a concise and complete summary of the investigation, including the investigators findings regarding the suspected insurance fraud and the basis for their findings and ensure that all investigative cases are thoroughly, promptly, and efficiently investigated and referred to the proper authority within the timeframe as mandated.
• Works with all members of the Claims Management, Underwriting and Marketing Teams, Claim Support Staff, Independent Vendors, Defense Counsel, and all other entities as may be required, to ensure effective implementation of fraud detection and deterrent protocols.
• Assists with the training of Central Mutual Insurance anti‑fraud personnel and Claims Staff in fraud detection, prevention, and suspect claim handling measures.
• Represents the Company at various industry, state and local organizations which focus on anti‑fraud activities.
• Coordinates investigation of complex suspect claims and assignments as warranted ensuring proper resolution and documentation within case management system.
• Collaborates with the SIU Director on all matters of the SIU function to include, but not limited to; investigation, investigative strategy, training and other department matters.
• Oversees reporting of all suspected fraudulent insurance transactions to the appropriate departments of insurance within the required time frames for their team.
• Establishes and maintains relationships with law enforcement, Department of Insurance officials and insurance industry personnel and assist them when required.
• Selects, trains, and develops new employees
• Sets expectations with regards to performance
• Communicates with, motivate and recognize employees
• Evaluates performance and conducts weekly check‑ins and performance reviews
• Manages staff and other resources appropriately

Required Qualifications

• Bachelor's Degree in Criminal Justice, Criminology, or Fraud Management and 2 years relevant experience
• Or 4 years of relevant SIU investigator/SIU Supervisor experience

Preferred Qualifications

• Licensure & Certification:
  None required;
  One or more of the following certifications/designations are desirable:
  Senior Claims Law Associate Designation, Certified Insurance Fraud Investigator Designation, and Certified Fraud Examiners Designation.
• Familiarity with anti‑fraud analytics programs as it relates to fraud prevention and identification

Knowledge, Skills, and Abilities

• SIU Supervisor needs to have significant knowledge and experience in all levels of P&C claim fraud investigation and reporting requirements to the various fraud bureaus.
• Advanced practical knowledge of conducting medical and property investigations in the field is necessary
• Good working knowledge of Word, Excel, and PowerPoint applications
• Demonstrated ability to build and maintain collaborative relationships with internal and external…