This job was posted by https://illinoisjoblink.illinois.gov : For more information, please see: https://illinoisjoblink.illinois.gov/jobs/12428469 This position requires residency within the US. Business hours: EST or CST.

REMOTE opportunity

Responsible for directing and coordinating the investigation related processes and services for the Enterprise. Directs the building of capabilities and skills focused on staff/external investigative services, including causation analysis, fraudulent claim-related matters and fraudulent premium audits. Directs team members and manages resources to achieve team goals and objectives that support corporate claims goals. Sets annual unit business goals, monitors production and business activity, ensures business process times are met, and establishes roles and responsibilities while maximizing use of employee talent. Oversees team member\'s workloads, acts as liaison between team members and other teams or technical staff and establish team goals, procedures, and strategies. Directs, coordinates, and evaluates performance of external investigation vendors. This position has responsibility to identify and analyze development trends within our claims organization.

RESPONSIBILITIES/TASKS:

• Directs all investigation services and processes for the Enterprise.
• Determines best practices and builds competencies in staff/external investigative services, including causation analysis.
• Leads team members including management, Regional Investigators and support staff. Evaluates employees to ensure the best utilization of unit talent.
• Ensures appropriate vendor management occurs to support the Enterprise business needs.
• Communicates and collaborates with all of the various operating unit departments/teams with whom the customer may interact or impact through daily processes.
• Ensures appropriate account management occurs to support Enterprise business needs.
• Develops unit goals, objectives, processes, procedures, and systems.
• Development of the investigation services annual departmental budget, monitors budget and identifies budget discrepancies. Researches the causes and makes recommendations.
• Identifies team-staffing needs and takes necessary measures to ensure appropriate levels of service.
• Consistently monitors workflows to maximize efficiency. Maintains an acceptable level of service and customer satisfaction and retention.
• Evaluates training needs, develops training plans and ensures implementation.
• Ensure efficient and effective use of company resources, evaluates processes and procedures, and develops new procedures.
• Maintains up-to-date technical knowledge of investigative core functions.
• Ensures maximum team effectiveness through coordination of team functions/activities and streamlining processes to minimize duplication of efforts and promote team efficiency.
• Mentors employees and develops career paths with growth opportunities.
• Provides guidance and advice when required or necessary and encourage/motivate employees in their daily efforts.
• Provide vision, leadership, planning, project coordination and management for the development of a cost-effective department while concurrently facilitating efficient operations to meet current and future business needs within the organization.
• Represent company in community and industry, programs and conferences.
• Participate in the development of programs as a strategic partner that supports the Company plan.
• Participate in development of annual departmental budget, monitor budget and identify budget discrepancies. Research cause and make recommendations.
• Responsibility for balancing workload to optimize the effectiveness of the department.

DIRECTION EXERCISED:

Directly supervises exempt a d non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include but are not limited to effectively interviewing, hiring, terminating, and training employees; planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor\'s degree in criminal justice, law enforcement, insurance, business, or related field required. Knowledge of insurance fraud and other relevant civil and criminal laws is preferred. Continuous learning required, as defined by the Company\'s learning philosophy. Certification, or progress toward, highly preferred and encouraged.

EXPERIENCE:

Ten years experience in claims investigation required. Five years leadership experience in a claims environment required. Workers Compensation insurance administration experience preferred.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

Must demonstrate leadership ability and team building skills to effectively super