SIU Investigator - Hollywood - Generali Global Assistance

Description

Embark on a Journey That Makes a Difference

At Generali Global Assistance (GGA), every day is an opportunity to help people explore the world with confidence. We're not just in the business of protectionwe're in the business of adventure and peace of mind. Whether it's a backpacker trekking through the Andes, a family cruising the Mediterranean, or a solo traveler chasing the Northern Lights, we're there to ensure their journey is safe and supported. From assisting with emergency medical claims to guiding customers through trip disruptions or ID theft, your work helps turn travel challenges into stories of resilience.

Set Sail on a Career Path to Success

Our teams value curiosity and collaboration while priding ourselves on fostering a welcoming and inclusive atmosphere for our employees. Elevate your journey through our internal programs, including:

• Diversity, Equity, and Inclusion (DEI) Committee
• Career pathing and Individual Development Plans
• Internal training and intern opportunities
• Women in Business Mentorship Program
• Employee awards and recognition
• Education and professional development assistance program

Passport to Perks Includes:

• Generous Employer contribution for health, dental, and vision insurance
• Paid Maternity and Paternity Leave
• Scholarship Program for Employee Dependents
• Company match on 401k
• Employee Assistance Program (EAP)
• Company paid short-term and long-term disability insurance
• Company paid life insurance
• Voluntary Pet Insurance
• Voluntary Legal Benefit
• Discounts on travel insurance
• Time off policies including vacation days, sick days, personal days, holidays and volunteer days (VTO)

Your Role on the Expedition

Under direct supervision of the Anti-Fraud Program and Subrogation Manager, the SIU Investigator will become a key fraud referent for Claims Operations. This person will directly manage the most complex and high value fraud investigation providing regular feedback to the Claims teams. The SIU Investigator provides regular support to Claims Operations in the detection and analysis of suspicious cases while identifying new fraud scenarios. Additionally, this role will contribute to the quarterly fraud reporting completion. This person will collaborate with UDW, Actuarial and Finance teams in regard of identification of fraud patterns.

Chart Your Course:

• Triage and investigation of the most complex/high value alerts reported by Claims Ops.
• Collaborate with external Investigation Partners.
• Investigate Fraud patterns reported by other departments: UDW / Actuarial / Finance Teams
• Identify suspicious cases / fraud patterns by your own, leveraging data analysis.
• Support in the detection/triage phases.
• Support in the Deny process.
• Contribute to the definition of manual detection procedures in close collaboration with Claims Supervisors/ Managers.
• Identify new fraud scenarios for fraud training program purposes, anti-fraud tool improvement and manual detection procedures improvement.
• Completion of the Quarterly Fraud Report: savings amount, investigation status
• Contribute to our continuous enrichment of the Fraud KPIs list.
• Be an active contributor of the Fraud Operational Committees.
• Act as an anti-fraud expert within the company, supporting peers to continuously improve maturity level.

Your Ticket to Success:

Required Qualifications:

• High School Diploma or Equivalent (GED) required.
• Minimum of 5 years of prior knowledge and experience in healthcare and/or insurance field for processing claims and or anti-fraud management.
• Strong analytical skills required including demonstrated ability to analyze raw data, draw conclusions, and develop actionable recommendations.
• Knowledge of developing standards, procedures, guidelines etc.
• Must be able to represent the organization in a professional and knowledgeable manner.
• Excellent verbal and written communication skills with ability to manage and prioritize multiple tasks.
• Computer skills necessary to work effectively: Windows Microsoft Word, Excel, and Power Point Proven ability to work under pressure, prioritize work and meet multiple deadlines.
• Excellent interpersonal and relationship building skills with a proven track record of leadership across functional lines that delivers business results.
• Excellent problem-solving skills and capability to troubleshoot the most difficult claim issues.

Preferred Qualifications:

• Experience or demonstrated knowledge of travel insurance, travel assistance or health care/insurance preferred.

Position Coordinates:

This is a hybrid role based out of our Pembroke Pines, FL or San Diego, CA office. As a hybrid role, you will be working onsite 2-3 days a week and working from home 2-3 days a week.

Time for Take-off:

While there is some flexibility in the hours, this position will be Monday-Friday during regular business hours (approximately 8:00am-5:00pm). Occasional overtime may be required according to business need.

One team. Every destination.

Generali Global Assistance is proudly part of the Europ Assistance Group and our products utilize a number of corporate and product brands. The brands for our North American team include the following:

• CSA: US travel insurance brand for retail, tour operator, cruise and lodging partners.
• Generali Global Assistance (GGA): The primary Corporate brand in the United States for our travel insurance, travel assistance, identity and cyber protection, and beneficiary companion products.
• GMMI: the industry standard for global medical cost containment and medical risk management solutions.
• Iris, Powered by Generali: identity and digital protection solution.

Explore new horizons apply today

Don't meet every single requirement? At Generali Global Assistance, we are dedicated to building a diverse, inclusive and enriching workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.

California Residents - Privacy Notice for California Residents Seeking Employment with Generali Global Assistance is available here:

The Company is committed to providing equal employment opportunity in all our employment programs and decisions. Discrimination in employment on the basis of any classification protected under federal, state, or local law is a violation of our policy. Equal employment opportunity is provided to all employees and applicants for employment without regard age, race, color, religion, creed, sex, gender identity, gender expression, transgender status, pregnancy, childbirth, medical conditions related to pregnancy or childbirth, sexual orientation, national origin, ancestry, ethnicity, citizenship, genetic information, marital status, military status, HIV/AIDS status, mental or physical disability, use of a guide or support animal because of blindness, deafness, or physical handicap, or any other legally protected basis under applicable federal, state, or local law. This policy applies to all terms and conditions of employment, including, but not limited to, recruitment and hiring, classification, placement, promotion, termination, reductions in force, recall, transfer, leaves of absences, compensation, and training. Any employees with questions or concerns about equal employment opportunities in the workplace are encouraged to bring these issues to the attention of Human Resources. The Company will not allow any form of retaliation against individuals who raise issues of equal employment opportunity. All Company employees are responsible for complying with the Company's Equal Opportunity Policy. Every employee is to treat all other employees equally and fairly. Violations of this policy may subject an employee to disciplinary action, up to and including termination of employment.