Fraud & Recovery TPA Analyst

AIG - Atlanta, GA

Full-time - Mid Level

Atlanta, GA

Insurance Carriers and Related Activities

About the position

At AIG, we are reimagining the way we help customers manage risk. As a Claims Fraud Investigator, you will play a crucial role in this transformation, contributing to the growth of your skills and experience as a valued member of our team. Our Claims teams are recognized as the proven problem solvers for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. We pride ourselves on delivering responsive, fair, and professional service with empathy and efficiency, supported by a robust stakeholder feedback loop and consistent processes and leadership. In this role, you will be responsible for all aspects of the investigation process, including the creation of investigation plans, identification and assignment of relevant inquiries, and reporting on findings. You will assist claims adjusters in progressing claims and leverage your knowledge and expertise to minimize fraud risk to AIG. Your focus will be on investigating medium-to-high complexity suspicious insurance claims or related activities across all lines of business, involving claimants, brokers, lawyers, medical providers, and more, to support the Claims organization. As a Claims Investigator, you will obtain and preserve physical and documentary evidence, coordinate necessary investigative techniques and resources, and handle a caseload across relevant jurisdictions. You will also testify and present evidence at administrative and criminal court proceedings as required, establish and maintain professional relationships with various stakeholders, and complete targeted claims reviews for all lines of business within AIG. Your role will also involve providing intelligence feedback to claims and underwriting departments regarding loss trends and opportunities for future fraud mitigation, as well as preparing objective and concise written reports of investigations when necessary.

Responsibilities

• Obtain and preserve physical and documentary evidence to support investigations.
• Coordinate necessary investigative techniques and resources, such as fieldwork through internal or external field resources, interviews, etc.
• Handle caseload across relevant jurisdictions while ensuring all tasks are completed properly.
• Testify and present evidence at administrative and criminal court proceedings as required.
• Establish and maintain professional working relationships with insureds, lawyers, corporate employees, vendors, police and relevant fraud bodies.
• Complete targeted claims reviews for all lines of business within AIG as assigned, including analysis, documentation of results and suggestions for improvement.
• Accurately identify and record all financial impact for cases worked in the case management system.
• Assist GIS and local management as appropriate in ensuring key deliverables and business objectives are met.
• Provide intelligence feedback to claims and underwriting departments regarding loss trends and opportunities for future fraud mitigation.
• Manage all aspects of the claims investigation, including analyzing facts on issues in question and reviewing interviews and statements of witnesses.
• Gather facts on issues in question through open-ended interviewing and statement taking of witnesses, employers, claimants, and other relevant witnesses.
• Prepare objective and concise written reports of investigations when necessary.
• Identify, create, and complete fraud training for various lines of business supported by AIG.
• Assist team on ad-hoc duties, projects, and other assignments delegated by Managers/Leaders.

Requirements

• College degree preferred or equivalent work experience.
• Advanced knowledge of criminal and civil justice systems and relevant data and compliance legislations.
• Excellent oral and written communication skills and thorough working knowledge of MS Office applications.
• An understanding of local customs, insurance markets, and languages is desired.
• Ability to manage workflow to identify and pursue leads that would support a fraud case.
• Ability to work to tight timelines when necessary.
• Advanced working knowledge in investigating General Insurance Consumer & Personal Lines of insurance is a plus.
• Ability to analyze complex data sets to assess trends and identify opportunities to drive improvements.
• PC skills and experience with various database search systems, internet, and social networking for investigative purposes.

Nice-to-haves

• Experience in fraud investigation within the insurance industry.
• Knowledge of specific insurance lines and related fraud schemes.
• Familiarity with legal procedures and court testimonies.

Benefits

• Comprehensive benefits package focused on health, wellbeing, and financial security.
• Professional development opportunities.
• Flexible work arrangements.
• Diversity and inclusion learning programs.
• Cultural awareness activities and Employee Resource Groups (ERGs).