Claims Predictive Analytics Specialist

Claims Predictive Analytics Specialist

Job Locations US-United States

Requisition ID

2024-17050

Category

Analytics

Position Type

Regular Full-Time

Overview

The Claims Predictive Analytics Specialist will examine claims and other data sources to detect potentially fraudulent activity.

They will conduct extensive research from both internal and external sources, to identify patterns, trends and anomalies that require further investigation.

The investigative analyst will develop investigations from the patterns, trends or anomalies identified and document all relevant activity / elements in accurate detail and in a timely manner within the investigative case management system.

They will prepare reports regarding the conclusions and recommendations drawn from the data to present information to Investigative Services management, state insurance fraud bureaus and / or law enforcement.

They will also make recommendations for future policies and procedures that will help detect, identify and / or prevent future fraud.

The analyst must maintain a solid understanding of AmTrust's mission, vision, and values and uphold the standards of the AmTrust organization.

Responsibilities

Analyze claim data and leverage analytical software to detect patterns of potential fraud.

• Collect data utilizing open source, law enforcement and third-party data to support lead generation and build out cases.
• Complete database searches and queries that are unique to each project.
• Utilize analytical software to review data and support investigation.
• Analyze information gathered by investigation and develop inferences from the data collected.
• Interview providers, claimants, witnesses, or any other individual(s) necessary to complete a case review or project.
• Develop detailed reports and link analysis charts that clearly define the data collected, investigation conducted, and conclusions identified.
• Prepare evidence package for referral to state insurance fraud bureaus and law enforcement agencies.
• Communicate with state insurance fraud bureaus and law enforcement and respond to any subpoenas and / or requests related to prosecution.
• Work with management to develop and implement policies and procedures to prevent future fraud.

Qualifications

• An associate or bachelor's degree OR five years of insurance claims experience.
• Experience with claims predictive models and ability to identify areas of improvement.
• Demonstrated ability to research, interpret and analyze large amounts of data and make informed, calculated decisions.
• Heightened understanding of the need to respect and protect confidential information.
• Perform other functionally related duties as assigned.
• Excellent problem solving, organizational, communication, and time management skills.

Preferred :

• Experience with ISO NetMap is preferred, but not required.
• Background in investigative services is preferred, but not required.

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What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include : Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected.

This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice.

Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices.

It is an integral part of who we are as a company, how we operate and how we see our future.

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