Special Investigations Specialist - BiBERK & THREE

Company:
NICO National Indemnity Company

As a member of the Berkshire Hathaway group of insurance companies, we offer outstanding opportunities for professionals interested in working with a successful company. We offer unparalleled financial strength, stability and "large company" benefits, in addition to an exciting, friendly, "small company" atmosphere.

Essential Duties and Responsibilities:

1. Respond to fraud related inquiries and referrals to SIU from Claim Specialists and Examiners and from automated initial screening system; search restricted, subscription-based and public databases, making maximum use of web-based resources; identify and refer to SIU Examiner circumstances potentially requiring retention of investigators and/or referral to regulatory or law enforcement authorities; coordinate with independent adjusters, investigators, law enforcement and regulatory authorities, to provide and obtain information for enhanced investigation of particular Claim Files. 50-70% Daily
2. Review, classify, log and track inquiries and referrals to SIU, applying guidelines to determine whether providing information is sufficient or further SIU action is appropriate. 5-10% Daily
3. Create and maintain a positive and close working relationship between SIU and Claim Examiners and Claim Specialists; assist in preparing materials and present fraud prevention training to Claim Operations and Underwriting units; encourage referrals to SIU of circumstances indicating high potential for fraudulent information or conduct; prepare and distribute information to Claim Operations regarding improved claim resolutions resulting directly from Examiner and Specialist referral and inquiries to SIU. 10-20% Daily
4. Perform data mining of internal systems to detect Insured, Claimant or vendor reporting, payment or other patterns indicating potentially fraudulent information or conduct; support and assist SIU Examiner in identifying potentially fraudulent information or activities revealed by inquires and referrals to SIU and in providing appropriate SIU response to all inquiries and referrals. 5-10% As Needed
5. Research, collect and organize claim data and prepare and complete periodic reports required by insurance regulatory authorities regarding fraud prevention activities of primary, BHHC and selected affiliated companies; maintain a comprehensive, well-organized and logically consistent system for recording all significant SIU actions and retaining all SIU-related materials in the Claim Information System, ImageRight and elsewhere; design and prepare charts, spreadsheets, and other visual aids and materials for presentations to management, counsel, law enforcement and regulatory authorities regarding general and specific SIU activities; review, approve within authority, and pay bills from investigators/vendors retained by SIU. 5-15% As Needed
6. Perform other duties as assigned.
A comprehensive benefits package is available for regular, full-time employees, including health, vision, dental, life and disability insurance as well as a 401(k) with company match. We also proudly offer 100% upfront tuition reimbursement to regular, full-time employees, to further your education. Our Omaha office boasts a complimentary state-of-the-art, on-site gym, a robust wellness program, low-cost downtown parking, and numerous volunteer and networking opportunities with other emerging professionals.