Claims Fraud Discovery Unit Professional
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The Internal Claims Fraud Discovery Unit is responsible for detecting instances of improper claim handling and improving the system of preventative and detective controls related to internal fraud.
Under general supervision, this job is responsible for auditing Allstate national claims operations to identify improper claim handling and payment activity. The employee in this job leads audits of moderate to high complexity. This job relies heavily on strong analytical skills to identify trends at both regional and nationwide levels and tailors audit procedures accordingly. The role is also relies on fluent knowledge of claim handling to evaluate documentation and identify evidence or patterns in claim files that my indicate improper activity.
Risk Management and Compliance
- Independently leads risk based audits under the general instruction of the team audit manager
- Identifies risks associated with internal controls and connectivity to internal fraud schemes
- Creates or designs own audits based on investigation
- Collaborates with others to identify and assess new or potential risks
- Proactively and effectively communicates ideas on how to improve daily work and enhance the potential to detect fraudulent claim practices
- Identifies risks and informs business partners; able to explain reasoning on how risk would/did take place
- Utilizes creative methods to analyze data, with varying complexity, to identify trends or outliers that may not have been visible in original contexts
- Utilizes data and understanding of fraud schemes to create new fraud detection enhancements
- Effectively coordinates audit procedures and findings with enterprise partners such as claims field leadership, technology, Special Investigative Unit, enterprise investigative services, human resources, etc., as appropriate
- Reports on key outcomes from audit engagements, including summary of procedures, findings and recommended response, and process improvement opportunities
- Perform other duties as assigned
- Merges and organizes large data sets and reviews for inconsistencies; audits for trends
- Performs analyses on claim payment data to identify patterns or indications of potential fraud
- Bachelors degree in related field preferred
- Experience performing claim file reviews highly preferred, approximately 2-5 years.
- Desire to work for cross-functional teams and/or rotational roles outside the Allstate claims organization
- Ability to interact effectively, and coach others on interacting effectively, with internal or external customers and act with empathy
- Maintains and applies knowledge of fraud trends and applies to audit approach and in interpretation of findings
- Knowledge of existing data elements, where they are stored, and how to capture them
- Skill in investigating, evaluating and settling complex claims
- Broad knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards
- Strong proficiency in investigative protocols, and the methodology behind them;
- Experience with multiple claims disciplines and lines of business, as well as understanding of the Allstate claims organization
- Broad industry knowledge to discipline practices, including best practices, to support the business unit
- Broad knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data
- Broad knowledge of problem solving and preparation of reports for analysis
- Broad ability to leverage learned technical skills in support of team objectives
- Broad conflict management and problem resolution skills in managing internal and external customer relationships
- Broad problem solving skills to continuously improve business outcomes
- Broad Broad knowledge of training facilitation and coaching skills
The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug screen.
Good Work. Good Life. Good Hands®.
As a Fortune 100 company and industry leader, we provide a competitive salary – but that's just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, you'll have access to a wide variety of programs to help you balance your work and personal life -- including a generous paid time off policy.
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Allstate generally does not sponsor individuals for employment-based visas for this position.
Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.
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It is the policy of Allstate to employ the best qualified individuals available for all jobs without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity/gender expression, disability, and citizenship status as a veteran with a disability or veteran of the Vietnam Era.
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