The Investigator, Fraud Operations undertakes the review and analysis of referrals for questionable claims, policy, supplier, and other potential fraud issues to determine whether investigation is required and the subsequent assignment of an investigator.
This individual will utilize various methods, including technology tools, and investigative resources to validate the potential fraud issues or concerns.
The role also has responsibility for the daily handling of incoming items via the Fraud Information Centre, and the Terrorist and Sanctioned Parties screening.
Evaluate referrals from internal and external sources to determine questionable claim, policy, and supplier issues requiring investigation
Decide if an investigation is warranted
Prioritize assignments based on fraud management accountability, and case prioritization guidelines to determine resource availability, reputational impact to company, and deterrent impact
Provide feedback and / or coaching to referrers on quality of referral, and awareness of potential fraud
Send appropriate alert notifications and investigation assignments based on findings
Initial intake of tips and creation of tip record in case management system
Undertake telephone interviews / statements from tipsters
Handle emergency and after hours email and telephone fraud referrals
Undertake Terrorist and Sanctioned Parties screening
Review and action of requests for investigative assistance / tasks
Participation in investigation or project investigations as assigned
Assist other investigators with additional data required over the course of the investigation or follow up on leads submitted though investigators
Liaise with Fraud Management or other investigative team colleagues, and the Claim, Underwriting, and Legal operations
Required Knowledge, Skills & Experience
CIP designation or working towards CIP
Minimum 5 years working in claims or underwriting capacity within an insurance company. Strong technical knowledge specific to claims line of business.
Investigative or litigation background.
Bilingualism in English and French would be considered a strong asset
Strong understanding of claims and underwriting processes
Superior analytical, problem-solving and decision-making skills
Strong customer service and communication skills ability to communicate diplomatically and empathetically
Strong verbal and written communication skills, including presentation skills
Assertive and comfortable with challenge and ambiguity
Technical knowledge of all insurance lines of business, including policies, claims, and related legislation
Investigative strategies and requirements / legislation
Ability to make confident and objective decisions in matters having high potential for legal precedent or legal dispute
Ability to source, understand, and analyse data
Ability to maintain confidential information
Strong knowledge of systems or understanding of various platforms used within the industry
Rotational shared responsibility for 24 / 7 on-call availability for handling of after-hours email and telephone fraud referrals (Fraud Information Centre)
Ability to work evenings or weekends, as required
Aviva Canada is committed to providing accommodations for people with disabilities during all phases of the hiring process including the application process.
If you require an accommodation because of a disability, we will work with you to meet your needs. Applicants need to make their needs known in advance.
If you are selected for an interview and require an accommodation, you are encouraged to advise the Talent Acquisition Partner who will consult with you to determine an appropriate accommodation.