You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
The SIU Investigator on our Case Management team investigates suspicious or potentially fraudulent activity across all lines of business. Their primary role is to investigate suspected insurance fraud claims. Working with moderate direction, the Investigator handles medium- to high-complexity matters. They gather and document facts that help claim professionals make better, more timely claim decisions, so legitimate claims get paid and fraudulent ones are detected and prevented.
JOB DESCRIPTION:
Essential Duties & Responsibilities
Performs a combination of duties in accordance with departmental guidelines:
- Conducts detailed analysis and completes thorough and timely investigations of suspected claim and/or provider fraud by following Best Practice Guidelines and collaborating with insureds, claimants, witnesses and experts.
- Develops and executes investigation strategy in collaboration with claim professionals, counsel, experts, insureds, and other stakeholders.
- Generally manages investigation activities independently, but requires guidance with unfamiliar or unusual issues; and coordinates/ oversees vendor service partner activities in the field.
- Maintains detailed, accurate and timely case records by following established Best Practices for file documentation and by creating comprehensive reports of investigative findings, and conclusions.
- Makes recommendations for claim and/or provider resolution by presenting findings and proposing solutions of moderate scope.
- Participates in process and outcome improvements by analyzing, summarizing, and reporting on key metrics, identifying opportunities and participating in the design and implementation of process or procedural improvements.
- Participates in building and enhancing organizational capabilities by developing and participating in the delivery of fraud awareness or regulatory compliance training and mentoring lower level SIU staff.
- Contributes to knowledge sharing with outside agencies by presenting cases of suspected claim fraud and/or testifying on behalf of the company in civil or criminal matters.
- Continuously develops knowledge and expertise related to insurance fraud by keeping current on related law, regulations, trends, and emerging issues and participating in insurance fraud or related professional associations.
In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia,California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees – and their family members – achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA’s benefits, please visit cnabenefits.com.
CNA utilizes AI-enabled technology during the recruiting process. For more information, please visit our careers page.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact leaveadministration@cna.com
