What are the responsibilities and job description for the Special Investigator Sr - Eastern Pennsylvania position at Sentry?
Creates and maintains an ongoing awareness on the part of all claim file handlers toward recognition of "red flags" in claim cases, leading to the detection, investigation and mitigation of potentially fraudulent and / or inflated claims. Performs a variety of duties and responsibilities to bring about resolution, compromise, denial and / or prosecution of fraudulent claims. Is accountable for controlling costs for contracted activities.
The ideal candidate's preferred location is in Eastern Pennsylvania, with travel required throughout the state and others.
What You'll Do :
As a Special Investigator Sr with Sentry, you will create and maintain an ongoing awareness on the part of all claim file handlers toward recognition of suspect behavior in claims cases, leading to the detection and resolution of potentially suspect / inflated claims. In addition, you will...
- Investigate moderate to complex claims both inside and outside the office, to identify suspect or inflated claims across all lines of business.
- Conduct scene investigations, take recorded statements, and assigning independent contractors as needed.
- Compile and analyze data and information on claims, from various sources, and verify legitimacy of documents as necessary.
- Maintain detailed investigation information within the SIU case management and claims systems, preparing summary reports to capture findings and recommending course of action to management, which may include referring to law enforcement.
- Develop and conducts anti-fraud awareness training for internal and external stakeholders to support the organizations risk management program and meet state mandated requirements.
- Serve as a representative / liaison between the company and industry and law enforcement fraud agencies to obtain assistance in conducting investigations.
- Have in depth knowledge of ICD9 and CPT coding in applicable PIP states
- Use experience in clinic inspections
- Demonstrate superior statement / EUO skill sets
What it Takes :
What You'll Receive :
At Sentry, your total rewards go beyond competitive compensation. Below are some benefits and perks that you'll receive.
About Sentry :
We take great pride in making Forbes' list of America's Best Midsize Employers. A lot of different factors go into that honor, many of which contribute to your job satisfaction.
Our bright future is built on a long track record of success. We got our start in 1904 and have been helping businesses succeed and protect their futures ever since. Because of the trust placed in us, we're one of the largest and financially strongest mutual insurance companies in the United States. We're rated A by A.M. Best, the industry's leading rating authority.
Our headquarters is in Stevens Point, Wisconsin, with offices located throughout the United States. From sales to claims, and information technology to marketing, we enjoy a rewarding and challenging work environment with opportunities for ongoing professional development and growth.
Get ready to own your future at Sentry. Opportunities await!
Joe Larsen
Talent Acquisition Specialist
Joe.larsen@sentry.com
Equal Employment Opportunity
Sentry is an Equal Opportunity Employer. It is our policy that there be no discrimination in employment based on race, color, national origin, religion, sex, disability, age, marital status, or sexual orientation.
