Key Responsibility Areas • Ensuring cases/checks are initiated as per client specifications. • Ensuring consistent quality and delivery. • Identifying insufficiencies/clarifications within the agreed time. • Meeting the established service levels and TAT’s. • Ensuring continuous adherence to existing guidelines on various aspects of delivery, response to internal clients, mail etiquette. • Maintaining integrity, Discipline and confidentiality related to related policies/ procedures. • Ability to work in a team. • Communication Skills.
Investigate suspicious insurance claims, including those that are suspected to have stemmed from fraud, criminal activity, arson, falsified documents, or unnecessary medical procedures. Consult hospital records. Consult with physicians to get expert evaluation. Examine photographs and statements. Listen to or watch audio or video surveillance. Record data and statements in report. Obtain background information on claimants and witnesses using a universal database. Access personal information and identify Social Security numbers, aliases, drivers license numbers, addresses, phone numbers, criminal records, and past claims histories. Search for previous cases of fraud. Visit claimants to obtain oral statements. Inspect facilities and determine if doctors hold proper licenses and certifications. Perform surveillance work to determine if a claimant is performing rigorous activity that would rule out injuries in workers compensation claim. Take photos and document suspicious activity. Report all activity to insurance company for final determination. Testify in court cases when claimant is accused of fraud.
Knowledge of Background verification process including education check, reference check and address check. Preferably from background screening industry Ensuring cases/checks are initiated as per client specifications Completions of the assigned target on a daily basis Ensuring consistent quality and delivery