Job Description:

PRIMARY PURPOSE: 

• To review open and closed files for potential fraud; to coordinate surveillance and investigative vendors; and to attempt recovery in third-party criminal actions.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

• Reviews open and closed files for potential fraud.

• Reports claims with viable evidence pointing to possible fraud to the state agency.

• Attempts recovery in third-party criminal actions by filing liens and judgments with criminal magistrates.

• Coordinates surveillance and investigative vendors.

• Maintains the approved vendor list including vendor selection and delivery of product component offerings.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES:

• Performs other duties as assigned.

• Supports the organization's quality program(s).

QUALIFICATIONS:

• Education & Licensing Bachelor's degree from an accredited college or university preferred.

• Experience: Six (6) years of related experience required or equivalent combination of experience and education to include four (4) years claims management experience and two (2) years of fraudulent claims investigative experience.

Skills & Knowledge:

• Thorough knowledge of claims management processes and procedures

• Excellent oral and written communication, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation skills

• Good judgment and discretion skills

• Ability to manage multiple projects and set priorities

• Ability to work in a team environment

• Ability to meet or exceed Performance Competencies

• Skill:  Need multiple state licensing (CA, NY, WA, PA, FL, TX). Must be able to handle heavy litigation, coverage, contract reviews, tenders, catastrophic injuries.

WORK ENVIRONMENT:

• When applicable and appropriate, consideration will be given to reasonable accommodations.

• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

• Physical: Computer keyboarding, travel as required

• Auditory/Visual: Hearing, vision and talking

• NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

• The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.

• They are not intended to constitute a comprehensive list of functions, duties, or local variances.

• Management retains the discretion to add or to change the duties of the position at any time.

About ASK: ASK Consulting is an award-winning technology and professional services recruiting firm servicing Fortune 500 organizations nationally. With 5 nationwide offices, two global delivery centers, and employees in 42 states-ASK Consulting connects people with amazing opportunities.

ASK Consulting is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all associates.