Leader, Special Investigations Unit (SIU) Transformation (Finance)
JOB DESCRIPTION
ABOUT THE NORTH AMERICA LEGAL AND COMPLIANCE TEAM:
We seek highly motivated individuals to join our team who exhibit the best-in-class competencies listed below and embody the Chubb Legal and Compliance culture.
- We deliver high quality work product, services and solutions that demonstrate understanding of the needs and requirements of our business partners and support achievement of team goals.
- We adapt to changing business needs and environments through a proactive, flexible approach that achieves results and strikes the proper balance among all constituencies.
- We demonstrate character, integrity and professionalism, both within a team environment in Legal and Compliance and in fulfilling our responsibilities to our business partners.
- We build collaborative, trusting relationships with team members and business partners through superior communication skills, empathy and respect.
- We independently manage work responsibilities through commitment, dedication and accountability, and display an on-going commitment to self-improvement.
The Leader of SIU Transformation will lead efforts to update and modernize Combined's SIU Department. This individual will work with Combined's Claims Department and existing SIU staff to identify and combat instances of insurance fraud. The Leader will work collaboratively with the Claims Department to develop new ways to quickly identify and combat potential fraud in a business environment that values speed and service, allowing us to quickly process and pay legitimate claims for our policyholders. This individual will report to the Chief Compliance Officer.
MAJOR RESPONSIBILITIES:
- Work with the Chief Compliance Officer to develop and execute strategy.
- In coordination with the Legal Department and Chief Compliance Officer, assist the business in complying with regulatory requirements related to claim fraud investigation and reporting.
- Develop new tools and strategies to combat emerging insurance fraud risks including the risks associated with the use of AI to perpetrate insurance fraud.
- Develop new processes and tools to improve fraud detection while supporting efforts to streamline the claims adjudication process, allowing the Company to quickly pay all legitimate claims.
- Manage routine and escalated regulatory interactions and communications including collaboration with state insurance departments and law enforcement.
- Work collaboratively with Combined's Claims Department to develop new processes and strategies to combat claims fraud.
- Train and educate claims staff and other stakeholders on emerging trends in insurance fraud.
- Develop and maintain relationships with, and provide timely guidance and advice to, business partners.
- Assist in SIU reporting to both Combined management and state insurance departments.
- Assist in the preparation of responses to regulatory inquiries, complaints, and examinations.
- In coordination with Combined's Legal Department, outside counsel and law enforcement personnel, assist with high profile claim fraud investigations.
- Conduct regular monitoring and testing to confirm that adequate controls are in place to prevent claims fraud.
- Coordinate activities between Combined's SIU staff and Chubb SIU staff.
- Conduct trending analysis using data analytics and other reporting mechanisms to identify potential issues.
- Report and escalate issues and developments as required.
- 10+ years of insurance industry experience, preferably in the areas of accident and health related products.
- Bachelors degree or equivalent experience, experience and/or professional designations related to insurance claims handling, insurance fraud and SIU.
- Demonstrated understanding of the accident and health, and life insurance regulatory environment including HIPAA, GLBA, and other applicable privacy and data security regulations.
- Strong analytical and technical skills in using data analytics and a deep understanding of insurance claims and fraud issues.
- Demonstrated ability to develop relationships with business partners across the organization.
- Ability to consistently execute and deliver results.
- Ability to manage multiple projects in a dynamic business environment.
- Strong knowledge of MS Project, Excel, PowerPoint Word; and other legal/compliance research tools.
ABOUT US
OUR BENEFITS
As a Chubb corporate employee, you have access to one of the most comprehensive benefit plans in the business, designed to meet your needs and help you reach your financial goals. More details can be found here. Chubb is committed to supporting its employees with a comprehensive compensation package that is appropriate in the market where they work. Below are several of the many benefits we offer our employees:
- Health insurance
- Dental insurance
- Tuition reimbursement
- A company-match 401(k) plan
- Disability insurance
- Life insurance
- Employee referral bonuses
ABOUT COMBINED INSURANCE
Combined Insurance Company of America is a Chubb company and a leading provider of supplemental accident, health, disability, and life insurance products in North America. Headquartered in Chicago, with satellite office in Columbia, SC, Combined is celebrating over 100 years in business. We are committed to making the world of supplemental insurance easy to access and understand. The company has an A+ rating by the Better Business Bureau and an A + (Superior) financial strength rating by A.M. Best. We are ranked by VIQTORY as the number one Military Friendly® Employer in 2023 (over $1 billion revenue category), marking Combined's twelfth consecutive year on the Top 10 list. We pride ourselves on approaching all situations with a Positive Mental Attitude (PMA) and encouraging collaboration.
ABOUT CHUBB
Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.
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