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Insurance Fraud Investigator

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We're seeking a skilled Fraud Investigator to join our Counter Fraud Services team at First Central Insurance Management Ltd. As a Fraud Investigator, you'll play a crucial role in protecting our business and customers from the impact of fraud.

Key responsibilities include:

  • Investigating suspected fraudulent claims, ranging from Low Velocity Impacts to Staged and Contrived collisions.
  • Conducting telephone interviews with customers and engaging external suppliers, including accident investigators, motor engineers, and panel solicitors.
  • Assessing evidence, including intelligence, Police reports, medical records, and engineering evidence, to identify inconsistencies and determine the outcome.
  • Identifying cases of potential Fundamental Dishonesty, private prosecutions, or professional enabler involvement.
  • Providing advice and support to business areas regarding potential fraud risks.
  • Processing payments on claims files as required and in accordance with authorities.
  • Ensuring claim files are reserved accurately and reserves amended where required.
  • Meeting agreed fraud KPIs and targets.
  • Ensuring compliance with Company financial crime procedures and related policies.
  • Submitting Suspicious Activity Reports as necessary to the Company MLRO.
  • Ensuring compliance with TCF principles when liaising with customers.
  • Building and maintaining relationships both internally and externally.
  • To be compliant with health and safety policies at all times.
  • Ensuring compliance with company and other relevant standards/regulations at all times.
  • Producing high-quality written reports and advice for the business, including recommendations.
  • Any other reasonable duties as required.
  • Carrying out duties, activities, and tasks as directed within the Claims and Fraud pillar.

Requirements:

  • Strong experience of handling fraudulent customer, third-party damage, and personal injury claims.
  • Proven track record in investigating both opportunistic and organized motor fraud.
  • Managing a caseload with adherence to SLAs.
  • Proven track record of stakeholder management.
  • Strong understanding of motor insurance fraud and the purpose of a Counter Fraud Team.
  • Strong understanding of the various indemnity levels and the subsequent impact that this may have on the claim/policy.
  • An understanding of Part 7 and Part 8 Proceedings.
  • Strong understanding of the litigation process and the impact that this has on the business both procedurally and economically.
  • Strong understanding of regulatory responsibilities (SMRC).
  • Excellent knowledge of FCA requirements (including TCF) and the regulatory framework relating to general insurance.

Skills and qualifications:

  • Strong communication skills, both verbal and written, and negotiation and influencing skills.
  • Good time management and organization skills with the ability to prioritize work.
  • Analytical and problem-solving skills, with the ability to adopt a logical approach to resolving problems.
  • Excellent customer service skills.
  • Computer literate, to include Word, Excel, PowerPoint, and the internet.

Behaviours:

  • Self-motivated and enthusiastic.
  • Consistently demonstrates a positive attitude.
  • Can receive and give constructive feedback.
  • Adept at working on own initiative and as part of a team.
  • Emphasis on attention to detail and accuracy.
  • Passionate about reducing the business exposure to fraud risk.