Share Email Opening
Title

SIU Claims Analyst 

Location Ohio - Cleveland  
Territory/Region  
Category Claims  
Description

Qualifications:

1.  Individual will be responsible for reviewing industry intelligence information and determining potential exposure for National General Insurance Company. Individual will use the NetMap For Claims data mining application in this process and communicate findings to other SIU staff.

2. Individual will be responsible for reviewing questionable claim payments that are identified by the check audit system and verifying their authenticity. The following guidelines will be adhered to:

•       Individual must view the invoice, bill or payment support document before approving the audited payment.

•       Processing errors should be corrected with manager supervision and reported in "Comment" field.

•       Suspect items must be forwarded to SIU for review and investigation.

3. Individual will be responsible for identifying additional criteria that should be used to identify questionable payments as well as tracking the success of the current audit criteria's.

4. Individual will be responsible for utilizing Netmap to proactively review payments for potential issues.

5.  Individual will be responsible for developing and completing specific tasks associated with internal investigation action plans.

List of required qualifications for this position:

Bachelor Degree or equivalent business experience (Internal audit/investigation, field investigation and/or claims handling experience)

•       Understanding of claim  handling procedures as well as a knowledge of the payment process for all systems.

•       Basic understanding of the claims/SIU policies and procedures; and ability to quickly review payments to identify payments that do not have supporting documentation and require further review.

•       Ability to work diligently while reviewing multiple payments on a daily basis 

•       Understanding of Indicators of Internal Fraud

•       Ability to develop action plans for internal investigations

•       Prefer successful completion of the following:

-Claims handling classes

-AEI Coursework (FCLS OR FCLA)

-Indicator of Claims fraud training class

-CFE designation (Certified Fraud Examiner

List of qualifications desired for this position:

Desired candidate will have both claims handling experience and investigative/ internal auditing experience. 

Strong understanding of the documentation required for claim payments to be issued. 

Completion of Indicators and Elements of Agent and Underwriting Fraud

Extensive experience working with both Claims system, Policy Management System,  Microsoft Outlook, Excel and Word programs

CFE designation, Internal audit/investigation and/or field investigation experience is strongly preferred.

Experience in the usage of data analysis software and performing link analysis.

 

Note: Depending on qualifications this position may be filled at the grade level of K or J.

 

 

 
Position Requirements

Technical Competencies - Associates Degree or equivalent business experience

Obtaining/Maintaining appropriate licensing or education requirements

Develops understanding of claim and underwriting policies & procedures; refers questions to supervisor.

Has a basic understanding of the claims/underwriting/SIU policies/Internal Audit and procedures; exhibits sound interpretation of policies & procedures in resolving investigations.  May still need some assistance from supervisor.

Demonstrates the ability to interpret and apply investigative findings, accurately to the claim/risk, and determines an action plan.  Often requires assistance on more complex investigations.

Limited Investigative Background

Prefer successful completion of the following:

            -Database Search Techniques (AutoTrack, Equifax, CDB, ISO).

-Case Link Search Techniques

-Indicators of Fraud training classes

-Policy Operations Foundation Training

 

  • Additional Competencies - Requires a high degree of initiative, mature judgment, and discretion.
  • Strong communication skills. Ability to resolve conflicts when delivering results.
  • Strong computer skills including prior experience with retrieving information from various databases, on line services, and policy or claims processing systems.
  • Demonstrates a general understanding of claims handling guidelines for varying loss types, insurance regulations and accepted practices. .
  • Demonstrates an understanding of the insurance industry and organizational relationships of the company.  Also, demonstrates an understanding of the functions of other departments, such as Internal Audit, Policy Ops, and Marketing.
  • Demonstrates the ability to handle confidential information in a professional manner.

 

 
About the Organization National General Insurance is one of the largest automobile insurers in the United States. National General Insurance offers a variety of property and casualty products, including personal auto, RV, motorcycle, commercial auto and homeowners insurance. With a nationwide network of claims professionals, local independent agents and a 24-hour, toll-free claims hotline available 365 days a year, National General Insurance provides superior claims service for its customers.

National General is a fast paced, dynamic, and entrepreneurial organization. Our team members live by and exemplify what we call the 4Es. At National General, we are Energized, Engaged, Empowered, and we Execute every day in order to provide an exceptional experience for our customers! We are passionate about our organization and the value that we add every day. A successful candidate with National General will embody the 4Es. Our team is poised to outperform the competition. We are National General Insurance and with us you can be extraordinary! Come join our team!

In addition to a phenomenal career opportunity, National General Insurance offers an excellent benefits package including:

• Paid Training
• Medical, Dental, Vision benefits
• Wellness Programs
• Life and Short/Long Term Disability Insurance
• 401k w/ company match
• Company Paid Holidays
• Generous Time-off policy
• On-site Healthcare Clinic (Winston-Salem and Cleveland offices)
• Subsidized parking (Downtown Cleveland)
 
EOE Statement We are an Equal Opportunity Employer.  
Req Number CLA-13-00076  

This position is currently not accepting applications.

To search for an open position, please go to http://NationalGeneral.appone.com



WE ALSO RECOMMEND

Other Jobs Within Same Category
Field Claim Rep Trainee / Sr. in Gastonia, North Carolina
Posted on: 3/26/2015
[Apply Now]

Claims Service Consultant in Winston-Salem, NC
Posted on: 3/26/2015
[Apply Now]

Bodily Injury Claims Representative in Cleveland, OH
Posted on: 3/25/2015
[Apply Now]

Claims Service Consultant in Cleveland, OH
Posted on: 3/25/2015
[Apply Now]

SIU Claim Representative in Cleveland, OH
Posted on: 3/25/2015
[Apply Now]


Other Jobs Within 60 Miles
Business Systems Analyst/Testing in Cleveland, OH
Posted on: 12/22/2014
[Apply Now]

Human Resources Senior Manager/Director in Cleveland, OH
Posted on: 3/27/2015
[Apply Now]

Business System Testing Analyst in Cleveland, OH
Posted on: 1/29/2015
[Apply Now]

Business/Testing Analyst in Cleveland, OH
Posted on: 2/10/2015
[Apply Now]

Part-Time Insurance Service Representative in Cleveland, OH
Posted on: 12/3/2014
[Apply Now]



Follow us See who works here:
 


AppOne.comTM   copyrightŠ1999-2015 HR Services, Inc.
Click here for technical assistance.