Job Description

s:

• To collect and collate key information related to all manual and automatic referrals routed through locations within their area of responsibility.
• Conducting a thorough review of all incoming fraud referrals. This review will include an analysis of Activity Notes, identifying key claim information/documentation and any previous investigative work conducted, as well as any information available through standard claim database searches.
• Create new case files in the Investigations Case Management System for each referral received and forward all relevant case documentation, along with a completed checklist, to the appropriate investigations unit.
• Required to play a key role in managing dedicated mailboxes for new investigations referrals and administrative case updates, as required.
• To provide any necessary feedback to the Investigations Unit on the quality of referrals. This process is key as part of their role in ensuring that appropriate information is being provided with all referrals so that the Investigations Unit can deliver training to claims handlers who are making manual referrals. This collaborative process will increase quality of referrals for the Investigations Unit.
• Required to provide specific input regarding system-generated (automatic) referrals. This input will be used to make any necessary adjustments to fraud detection models to improve the quality of automated referrals.
• Collaborate closely with the Investigations Unit and Regional Managers to ensure smooth running to the administration process and assist SIU management with ad hoc projects or tasks.

Job requirement/qualifications:

• Must possess a thorough understanding of insurance claims processes.
• Must have 2-3 years of experience in insurance or fraud investigations. Experience in multiple lines of business is a plus.
• Basic understanding of trends and behaviors in insurance fraud.
• Strong written and verbal communication skills.

Hybrid Working Arrangement8:30am-5:30pmMonday - FridayAbout AccentureAccenture is a leading global professional services company that helps the world\xe2\x80\x99s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services\xe2\x80\x94creating tangible value at speed and scale. We are a talent- and innovation-led company with 750,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world\xe2\x80\x99s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. We are uniquely able to deliver tangible outcomes because of our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song. These capabilities, together with our culture of shared success and commitment to creating 360\xc2\xb0 value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360\xc2\xb0 value we create for our clients, each other, our shareholders, partners and communities. Visit us atEqual Employment Opportunity StatementAll employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.Accenture is committed to providing veteran employment opportunities to our service men and women.

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