Zurich NA Sr. Claims SIU Investigator in Toronto, Ontario
Sr. Claims SIU Investigator
Directs, leads and conducts investigations of suspect fraud, high exposure, and complex investigations within an assigned geographic region / Line of Business (LOB). Suspect premium fraud cases may also be included in the type of cases worked. Cases may also include claimant, third party vendor, and or Agent (Broker) matters. Receives limited to moderate technical direction and works within broad limits and authority on highly complex assignments to ensure that all claims fraud risks are effectively and efficiently governed and managed.
• Bachelor's Degree and 7 or more years of experience in the professional investigations involving other financial crimes or Insurance claims investigation with a law enforcement agency area
• High School Diploma or Equivalent and 9 or more years of experience in the professional investigations involving other financial crimes or Insurance claims investigation with a law enforcement agency area
Bachelor's Degree and 9 or more years of experience in multi-line commercial claims handling
Bachelors Degree and 7 or more years of experience in SIU insurance claims handling
• In depth knowledge of claims process
• In depth knowledge of regulations and statutes in the assigned territory
• Microsoft Office skills
• Conducts complex, sensitive, or high exposure investigations within assigned geography or Line Of Business in the local Business Unit, or outside normal geography/Line Of Business, as required.
• Researches information and database searches, prepares surveillance assignment, assigns to vendor and reviews results with subsequent documentation.
• Leads investigative team on the resolution of highly complex, sensitive, and/or suspect organized ring cases within geography.
• Investigates all aspects of highly complex claims referred for investigation, including circumstances of loss, background of individuals/businesses and underwriting aspects.
• Participates in department and Business Unit initiatives as directed.
• Gathers information from various sources and interviews witnesses.
• Maintains impeccable documentation, back up and files to support all aspects of the case.
• Prepares and provides investigative reports to Claims, Management, Business Partners, Business Units and other required stakeholders.
• Acquire and efficiently organise the relevant evidence and information necessary to accurately assess whether or not there is a fraudulent aspect to individual claims or fraud ring/network claims.
• Collaborate with external agencies to secure information and data which is relevant to individual investigations.
• Conduct desk and field investigations including face to face interviews with customers, witnesses and other persons relevant to the investigation, obtaining formal written statements.
• Adheres to local regulation and Zurich Claims governance requirements throughout the investigative process to ensure that all information and data is obtained within data protection rules and regulations.
• Liaises closely with senior managers and claim handlers throughout the investigative process and ensuring that all stakeholders are immediately aware of any important issues that are identified.
• Identify promptly cases which need to be further escalated.
Add. Job Functions:
Serves as primary subject matter expert for the development of technical training and team member coaching.
A future with Zurich
Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 148 years of experience managing risk and supporting resilience. We are a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. Today, we serve more than 25 industries, from agriculture to technology and insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, Zurich strives to provide ongoing career development opportunities and foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our people, our customers and the communities we serve.
As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers’ expectations. Zurich is committed to providing a diverse, inclusive and barrier-free environment resulting in an accessible organization for employees, customers, and other parties who interact with, or on behalf of, Zurich. We strive to achieve a workplace free of discrimination of all forms, including discrimination on the basis of physical or mental disability, or medical condition. If you are interested in a job opportunity, please advise if you require an accommodation, so we can work with you to provide a more accessible process.
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EOE Disability / Veterans