Helps to mitigate legal exposure, insurance and claims fraud risks to the organization by enforcing company policies, procedures and regulatory requirements. Possesses and applies broad knowledge of concepts and principles; performs multiple moderate to complex suspicious claims investigations to determine if fraud can be substantiated and claim payments should be paid or denied.

Responsibilities:

  • Responsible for investigating and analyzing multiple moderate to complex investigations that have been referred to the Financial Crimes Unit (FCU) for potential fraud, including investigating potential fraudulent activity committed by insurance agents.

  • Performs a thorough investigation including; (1) quickly gathering and analyzing the facts, (2) assessing the associated risks; and (3) providing prompt conclusions and recommendations to management.

  • Utilizes data analytic tools to identify moderately complex and occasionally complex claims for investigation and/or for support in the evidence of the fraud

  • Reviews the facts of a case and works with Management team to determine if there is potential application fraud, if claim payments should be paid or denied, if fraud can be substantiated and supports a lawsuit or state fraud filing.

  • Review current policies and procedures; identify and help to implement new and/or enhanced practices.

  • Works independently, prioritizing own responsibilities, and managing own workload.

  • Assist in responding to regulatory inquiries with direction from senior levels.

  • Collaborate with business partners to gather facts and educate them on red flags and controls to mitigate fraud risks.

  • Foster a culture of compliance to help prevent, detect and reduce company risk with respect to financial crime.

  • Assist team members with research and assigned tasks and provide training to supported teams.


Qualifications:

  • Bachelor’s degree in business, marketing, pre-law or other relevant field, or equivalent education and experience.

  • Four years of insurance experience or regulatory, securities, compliance experience.

  • Areas of experience desired may vary based upon assigned compliance functions and may include contract development, claims, underwriting, legal research, fraud or anti-money laundering investigations and/or communications.

  • Written and verbal communication skills.

  • Analytical and research skills.

  • Proficiency using MS Office tools.


Preferred Qualifications:

  • Experience with insurance products

  • Experience with investigating potential insurance fraud

Working Conditions:

  • Hybrid office environment (3 days per week): Baltimore/Cedar Rapids/Denver/Philadelphia

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Compensation:

  • The Salary for this position generally ranges between $75,000 - $85,000 annually. Please note that the salary range is a good faith estimate for this position and actual starting pay is determined by several factors including qualifications, experience, geography, work location designation (in-office, hybrid, remote) and operational needs. Salary may vary above and below the stated amounts, as permitted by applicable law.

  • Additionally, this position is typically eligible for an Annual Bonus based on the Company Bonus Plan/Individual Performance and is at the Company’s discretion.

This job description is not a contract of employment nor for any specific job responsibilities. The Company may change, add to, remove, or revoke the terms of this job description at its discretion. Managers may assign other duties and responsibilities as needed. In the event an employee or applicant requests or requires an accommodation to perform job functions, the applicable HR Business Partner should be contacted to evaluate the accommodation request.

Disclaimer:
Beware of fake job offers!

We’ve been alerted to scammers impersonating Transamerica recruiters, particularly for remote positions. Please note:

  • We will never request personal information such as ID or payment for equipment upfront.

  • Official offers are sent via DocuSign following a verbal offer—not through text or email.