Oversees all aspects of an organization's risk management function. Responsible for planning and developing business analysis, risk modeling, and loss prevention programs. Designs strategic initiatives to protect assets from economic, market, and regulatory risks that the organization is exposed to. Requires a bachelor's degree. Typically reports to Chief Executive Officer (CEO). Top level or C le...
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Alternate Job Titles: Claim Compliance Investigation Director | Insurance Compliance Investigation Director | Insurance Fraud Investigation Director | Suspicious Claims Investigation Director
Directs the claims investigation function to detect, investigate, and prevent fraudulent or suspicious claims activity. Oversees managers and investigators responsible for special investigations, surveillance, and fraud analysis. Develops investigation strategy, protocols, and standards aligned with legal and regulatory requirements. Analyzes fraud trends and investigative outcomes to inform preve...
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Investigates assigned claims to determine validity, detect potential fraud, and gather facts to support claim decisions. Conducts interviews, surveillance, record reviews, and field investigations to obtain relevant evidence. Analyzes statements, documentation, and data to identify inconsistencies and indicators of fraud. Documents investigative findings, evidence, and conclusions in clear and acc...
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Manages the compliance programs, policies, reporting, and practices for an organization or business. Ensures that all activities follow regulatory requirements related to the governance of the organization as well as any industry-specific or location-specific laws. Oversees internal controls and auditing systems that monitor and report on regulated activities and processes. Implements risk-based c...
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Manages the compliance programs, policies, reporting, and practices for an organization or business. Ensures that all activities follow regulatory requirements related to the governance of the organization as well as any industry-specific or location-specific laws. Oversees internal controls and auditing systems that monitor and report on regulated activities and processes. Implements risk-based c...
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