Counter Fraud Investigator
Posted on Aug 1, 2019 by CV-Library
Salary: £26,000 - £29,000
Hours: Monday - Friday 9am - 5pm
Location: Haywards Heath
Due to the continued success and expansion of the company, they are now looking to recruit a Claims Fraud Investigator to join their dynamic and forward-thinking teams.
The main purpose of this role is to pro-actively screen and investigate portfolio of suspect motor accident claims.
Screening incoming RTA referrals against known fraud indicators and other risk factors, identifying cases where investigation is required.
Managing fraud rings and linked claim investigation, adhering to internal and IFB protocols.
Utilising a variety of desktop tools (CUE, MIAFTR etc) as well as various internet checks and databases to assist with claimant profiling and to determine the direction of the investigation.
Telephonic interviewing of claimants utilising specialist cognitive interviewing and conversation management techniques in order to further determine risk and separate honesty from inconsistency.
Pursuing follow up inquiries with external parties including regulatory and licensing authorities, other insurers and law agencies.
Providing focused instructions to, and subsequently liaising with, specialist investigative suppliers including field investigators, engineers and forensic specialists.
Assessing the completed 'evidential picture' in order to determine the correct outcome for the claim.
Managing claims caseload, in accordance with the claims philosophy, claims handling procedures and service levels.
Adhering to agreed personal authority limits, referring to line manager for authorisation where activity exceeds such limits.
Ensuring compliance with all regulatory requirements (including "treating customers fairly" principles).
Responding promptly and pro-actively to incoming telephone calls and correspondence by use of telephone, e-mail and letter.
Maintaining good file discipline and accurate reserves, together with an effective diary system which ensures that cases are reviewed on a regular basis.
Developing and maintaining effective relationships with colleagues and business partners.
Pro-actively managing personal training and development requirements.
Undertaking general claims tasks, as required
To adhere to Company processes with regard to FCA compliance and Treating Customers Fairly;
To ensure that DPA, FCA & TCF and other regulatory requirements are met.
Bodily injury claims handling experience
Investigation of suspect fraudulent RTA/bodily injury claims