Extend

Operations

• Real-Time Claim Review: Review claims in real time for potential cases of fraud/abuse, leveraging your information gathering and communication skills to ensure you have sufficient evidence to make a fraud determinations, and providing valuable feedback for Extend’s risk models.
• Risk Score Judgments: Review customer behavior and incidents using internal and external data and independently make decisions on customer risk scores. You will also have the power to recommend denials and approvals for claims.
• Fraud Investigations and Subject Matter Expertise: Bring your own experience to perform fraud investigations and deliver insights on emerging trends for fraud/abuse.
• The Procedure: Take ownership of each investigation and diligently follow all regulatory and departmental practices and procedures, making independent decisions based on facts and evidence, and reporting any non-standard escalations to your manager. Attend regular meetings and training for Fraud Operations best practices, and offer your insights into the latest trends for fraud/abuse.
• Cross-functional Work: Collaborate with Claims, Product, and Engineering, completing ad hoc tasks to evaluate and improve in-house models to detect fraud.
• Be Proactive and Adaptable: Drive team success and achieve both independent and collaborative goals, proactively completing additional tasks for the role as needed.

Fraud Operations Specialist