What are the responsibilities and job description for the Claims Special Investigation Unit Manager position at Westfield?
Job Description
The Claims Investigation Unit Manager lead the success of investigative operations and provides leadership to the assigned staff. The role ensures appropriate investigations are performed on claims utilizing knowledge of and experience with relevant tools, technologies, and techniques. The role identifies and leverages new sources of data to improve success of fraud analytic and predictive model efforts. The role communicates investigation related information to senior leadership and assist with business planning, processes, vendor selection, and budget management.
LI-DNI
Responsibilities
- Drives the consistent delivery of Special Investigation Unit practices and performance and reviews the acceptance / rejection of claim files and ensures that appropriate investigations are performed, and relevant facts obtained on assigned claims.
- Collaborates with Investigation leader on business planning, processes, guidelines, vendor selection, and budget management activities and identifies risk mitigation strategies, evaluates business technology and enhancement possibilities to support data mining and analytics.
- Performs talent management responsibilities including employee selection, performance management, technical coaching, career development, employee-related issues, employee morale and work environment and sets goals and objectives for team members for achievement of operational results.
- Reviews work quality, customer service, and reviews files, conducts quality assurance file reviews for assigned staff, identifies process improvement and best-practice sharing opportunities and manages priorities and workload distribution and removes barriers that impede progress.
- Gathers, organizes, and analyzes performance data and results, creates reports and communicates results with claims leadership and business partners and identifies and reports performance, trends, and opportunities and makes recommendations regarding areas of improvement.
- Reviews external investigations conducted by the agency contracted with the organization that potentially involves any fraudulent issues.
- Leads and motivates cross functional teams in the development of key initiatives and supports litigation preparation, including attendance at exams under oath (EUO's), depositions, and trials.
- Develops and maintains positive and effective business relationships with vendors, including officials, surveillance vendors, governmental agencies, etc.
- Identifies the training needs of the team, partners with Westfield University to design, develop, and deliver fraud-related training programs to claims professionals, underwriting, and agency personnel.
- Participates in professional industry groups and stays abreast of industry changes, advancements, and jurisdictional issues to communicate, develop, and incorporate best practices into the claims business and shares new information, best practices, and processes.
Qualifications
Location
Hybrid defined as three or more days per week in the office.
Behavioral Competencies
About Us
Founded in 1848, Westfield is a global leader in property and casualty insurance, delivering superior risk insights and innovative solutions to customers through a diverse portfolio of insurance products. Westfield underwrites commercial, personal, surety, and specialty lines of coverage through a network of leading independent agents and brokers in the United States and specialty products through Lloyd's of London Syndicate 1200. As a mutual insurance company with more than 3,000 employees, Westfield has revenues in excess of $4 billion and more than $10 billion in assets.
