Senior claims representative, siu

This individual is responsible for the accurate detection and in-depth investigation of potentially fraudulent insurance activity, ranging from complex medical and staged accident claims to simpler application fraud issues. Investigative activities will include in-person interviews and recorded statements. Prepares and presents reports of impartial results to management for decision-making. Performs field work as needed and coordinates efforts with industry fraud units, claim personnel, counsel, law enforcement and regulatory agencies. May provide evidence and testimony in cases where law enforcement agencies pursue prosecution. May conduct fraud awareness training and/or investigative research. The individual will work remotely and will be provided a company issued computer, phone and vehicle. Applicants must live in New Jersey preferably in either Middlesex or Monmouth County.

RESPONSIBILITIES

• Prioritize and handle multiple tasks simultaneously. Adjust to fluctuating workload.
• Good file analysis/decision making when reviewing file documentation.
• Maintain diary to meet requirements for status reports on all investigations.
• Successfully completes investigation addressing all referral issues.
• Will obtain nine hours of formal training per year.
• Will participate in conducting fraud awareness training to company associates.
• Network with law enforcement and other investigators within the SIU Industry.
• Adhere to privacy guidelines.
• Cover large geographic areas.
• Complete accurate monthly reports and submit to supervisor timely.
• On occasion, complete assignments in other parts of NY or NJ based on business need.

QUALIFICATIONS

• Must meet the following qualifications:
• Bachelor’s Degree
• Minimum of 7 years of insurance industry experience or five years of law enforcement experience involving investigation of insurance related crimes.
• Valid Driver’s License
• Strong Computer Skills (Microsoft Excel, Word, Access and Outlook)
• Strong verbal and writing skills
• Working knowledge of Home and Auto Policies/Claims
• Understanding of Underwriting and Premium Fraud investigations.
• Knowledge of medical terminology and treatment plans
• Bi-lingual in Spanish would be preferred

SALARY RANGE

The pay range for this position is $84,000 to $109,000 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.

PERKS & BENEFITS

• 4 weeks accrued paid time off + 9 paid national holidays per year
• Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision)
• Annual 401(k) Employer Contribution
• Resources to promote Professional Development (LinkedIn Learning and licensure assistance)
• Robust health and wellness program and fitness reimbursements
• Various Paid Family leave options including Paid Parental Leave
• Tuition Reimbursement

ABOUT THE COMPANY

The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner’s insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.