Serves as subject matter resource regarding fraud investigations
Assist and consult on claims with red flags, providing desktop investigative assistance
Drive innovation by integrating advanced AI tools and techniques as well as common vendor tools into claims processes to enhance and advance fraud fighting efforts
Consistently and proactively identify gaps in fraud detection systems and recommend solutions to increase efficiency and effectiveness
Continuously monitor the performance of fraud analytic models (both GMIC-designed and vendor models) to ensure effectiveness as fraud schemes shift and evolve, modifying models to ensure peak performance and limit false positives
Serve as subject matter resource regarding auto insurance fraud intelligence and analytics
Analyze intelligence from large datasets to uncover patterns, anomalies, and red flags indicative of fraud
Utilize predictive modeling tools to analyze fraud trends and provide insights regarding possible mitigation strategies
Collaborate with policy analysts, claims adjusters, legal team, and leadership to develop and refine fraud detection decision frameworks with effective alert systems

High School Diploma or equivalent required; Bachelor’s Degree preferred
3+ years of Special Investigation Unit (SIU) and/or Major Case investigation experience in auto insurance required
2+ years of professional business analytics experience required
3+ years of medical fraud investigation experience strongly preferred
2+ years of experience investigating fraud on California auto insurance claims strongly preferred
Must be able to obtain Property and Casualty (P&C) or Personal Lines License in at least (1) U.S. State within 30 days of start date

Auto Insurance Fraud Intelligence Analyst

Key skills