Manager, Special Investigation Unit
Location: Bethlehem, Pennsylvania
Description: Guardian Life of America is looking of Manager, Special Investigation Unit right now, this job will be delegated in Pennsylvania. Further informations about this job opportunity please read the description below. Management of Guardian’s Group Special Investigation Unit
Responsibilities:
Position Duties:
- Management of the day-to -day o! perations of the Group Special Investigation Unit. Includes the planning and organization of workflow, management of Chief Investigative position, management of Sr. Business Technical Analyst, 2 nd level supervision of Investigative staff. Recruiting of staff, performance appraisal process, legislative compliance, and administrative duties , facilitate SIU compliance with legislative and governmental anti fraud mandates
- Preparation and monitoring/tracking of budget and expenses for departmental operation. Forecast and budget for future needs. Track budget, identifies problem areas, and reforecast where necessary.
- Examine and provide approval for investigation plans developed and monitored by the Chief Investigator, Special Investigations when necessary. Provide guidance on an ad-hoc basis to Chief Investigator and Investigative staff on difficult situations on a case by case basis. Provide guidance to the Investigative, and Business Analyst positions; !
- Managerial oversight to assure thorough, and consistent a! djudication of fraud investigations while taking into account Guardian business considerations .
- Evaluate and triage the investigative viability of borderline fraud situations and proceed accordingly.
- Allocate available resources.
- Assure the utilization and update of various database sources of information. Assure investigator utilization of the STARS, STARSentinel, SIRIS systems, and SIU Case Tracking Database.
- Coordinate large-scale investigations with other insurance carriers and elements of law enforcement.
- Provide necessary testimony and depositions where required;
- Maintain a network of contacts with the FBI, US Attorneys Office, Office of the Inspector General, US Postal Inspection Service, other SIU units, and outside investigative services.
- Evaluate corporate initiatives relative to anti fraud compliance where requested to do so;
- Evaluate and make recommendations relative to latest technology fo! r application within Group anti fraud efforts. .
- Attend meeting on a local, and national level of various industry anti fraud associations. Maintain position on the Membership Forum of NHCAA.
- Assure Group/corporate compliance with statutory and federal anti fraud legislation. Assure compliance with state fraud reporting requirements. Assure satisfaction of investigator education and fraud awareness training requirements.
- Ensure up to date maintenance of STARS, SENTINAL, SIRIS, SIU Case Tracking Database, and other systems.
- Design, and distribute yearly web based fraud awareness training program.
- Administer the nationwide Fraud Detection Award Program.
- Assure quarterly production and distribution of the Fraud Bulletin
- Assure quarterly production and distribution of the SIU Anti Fraud Activity Report.
- Assure adequate coverage of both the Anti Fraud Hotline, and SIU WebPages.
- Manage the investigat! ion of internal fraud involving Guardian employees where requested !
- Negotiate monetary recoveries on extremely difficult cases.
- Work directly with the FBI on requests for investigative assistance.
- Coordinate resource intensive projects.
- Work with investigative staff to produce proactive anti fraud mechanisms to secure case leads
Position Requirements:
In satisfaction of NY Regulation 95 (11NYCRR86) effective 7/1/98:
Bachelors Degree in Criminal Justice or,
Bachelors Degree and 4 years of insurance investigation experience or,
5 years of professional investigation experience with law enforcement agencies, or
7 years of professional investigation experience involving economic or insurance related matters.
A proven supervisory/management track record.
10 years of varied claim /underwriting experience with emphasis on a Supervisory/Managerial level.
Knowledge of investigative principals and techniques.
A broad knowledge of the struct! ures, functions, responsibilities, reporting lines/culture at Guardian.
Insurance knowledge relative to different insurance product lines. Experience with Health, Life, AD&D, Loss of Income, Dental Coverage.
Excellent P/C and Internet skills. Proficiency with MS Office.
Experience with interviewing/interrogation/statement taking
Court experience
Ability to travel on behalf of Guardian
AHFI, CFE designation or NHCAA certifications
Outstanding communication skills
Self-Motivated with the ability to thrive in a non-structured environment.
Principal Working Relationships:
Internal Departmental Customer base within Guardian including the Law Department, Claims Department etc.
Law enforcement officials (FBI, US Attorney’s, District Attorney’s etc)
Outside counsel when approved by the Law Department
Alleged perpetrators of suspected fraud. (providers, insureds, corporate, etc.)
Outside investigative services SIU staff at other carriers
NHCAA staff and members
State re! gulatory officials for compliance purposes
Dental Consultant staff
SIU staff.
Competencies:
Customer focus
Respect for Diversity
Problem Solving
Self Assurance
Holding people accountable
Team facilitation.
Coaching
Analytical thinking
Collaborating with others
Focusing on detail
Continuously broadening expertise
Information seeking
Demonstrating initiative.
Additional information:
This job may require travel when necessary. The incumbent must be street wise, independent, objective, flexible and able to handle adverse situations. In certain situations investigations must be completed without regard for standard business hours on an around the clock basis. Recognition that many investigative assignments bear the potential of civil/criminal litigation.
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If you were eligible to this job, please deliver us your resume, with salary requirements and a resume to Guardian ! Life of America.
Interested on this job, just click on the Apply button, you will be redirected to the official website
This job will be started on: Wed, 13 Mar 2013 20:33:33 GMT
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