What are the responsibilities and job description for the Manager, Special Investigation Unit position at WCF Insurance?
JOB SUMMARY
This is an exempt position that reports to the Director, Investigation and Recovery. The person in this position provides administrative, investigative, and educational services to all WCF departments, policyholders, state law enforcement agencies, and other partners.
QUALIFICATIONS
- Bachelor's degree in a relevant field or equivalent work experience; master's degree preferred.
- At least seven years' experience in workers compensation insurance and property and casualty insurance fraud investigation, law enforcement, or criminal investigation.
- Certification as a Certified Fraud Examiner (CFE) or Certified Insurance Fraud Investigator (CIFI) preferred.
- Strong knowledge of insurance industry practices, standards, and terminology.
- Advanced proficiency in investigative interview techniques.
- Excellent organizational, decision-making, and analytical abilities.
- Proven leadership skills with a focus on team management, interpersonal relations, and customer service.
ESSENTIAL JOB FUNCTIONS
- Develop and implement investigation strategy to align with and support the corporate vision and objectives.
- Lead investigations into all types of workers compensation and commercial insurance fraud, including application, audit, claimant, policyholder, producer, underwriting, premium, and provider fraud.
- Manage a team of investigators and administrative staff, ensuring proper resource allocation in line with the department and company strategy.
- Oversee the maintenance and continuous improvement of core systems, including data dashboards, to optimize operations.
- Ensure prompt and effective resolution of investigation requests from internal and external stakeholders.
- Manage the selection, evaluation, and oversight of vendors, including private investigators and forensic experts.
- Establish and maintain a comprehensive system of policies, procedures, and workflows.
- Collaborate with law enforcement agencies, criminal prosecutors, and government bodies to ensure thorough and coordinated investigations.
- Utilize data and advanced technology to improve fraud detection and resolution processes.
- Review and prioritize fraud referrals based on their merit and validity.
ACCOUNTABILITY & REQUIREMENTS
- Prepare and submit annual compliance reports while ensuring ongoing training for all internal anti-fraud personnel.
- Maintain adherence to state regulatory requirements.
- Participate in investigation training sessions and meetings, sharing knowledge gained with company personnel
VALUES
The individual in this role must exemplify the core values of WCF, including a commitment to doing the right thing, excelling at their job, and helping others succeed, to uphold the company's mission of excellence.
WORKING CONDITIONS
This role is based in an office environment with controlled temperature and lighting. While there are no significant hazardous conditions, the position may involve high-stress situations requiring adherence to tight deadlines.
