SageSure

Investigator

• Applies knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third-party claims.
• Participates in the development of fraud prevention strategies.
• Applies knowledge of insurance industry products, services and processes in investigating claims. This includes insurance policy contracts, coverages and internal claims handling process and procedures.
• Applies knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
• Collects evidence of potential fraud through remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.
• Makes recommendations within defined authority guidelines.
• Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results of the investigation and recommended outcome.
• Establishes and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection and prevention.
• May serve as a resource team member on specific matters through demonstrated skill or training.
• Assists with the delivery of fraud awareness training initiatives in a defined environment.
• Handles CAT duty responsibilities as business requires.
• Identifies and handles existing and emerging risks that stem from business activities and the job role.
• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled.
• Follows written risk and compliance policies and procedures for business activities.

Special Investigator II

Claims Specialist

• Identify operational reporting opportunities with Claims department leadership.
• Develop data and visual dashboards that can be used to identify needed actions quickly.
• Work with leaders to incorporate operational data and dashboards into daily and weekly management processes.
• Analyze Claims data in Domo, AWS Redshift and Excel to provide actionable insights to stakeholders.
• Perform data cleaning, validation, and quality checks within visualization tools to ensure accuracy, reliability, and consistency of datasets.
• Translate business requirements into scalable business intelligence solutions to track KPIs for senior leadership and operational teams.
• Build complex dashboards and automated reporting systems that serve as operational controls.
• Establish a framework for understanding and efficiently using currently available operational claims data.
• Mentor other analysts.
• Develop, test, and optimize complex ETL workflows in Domo for performance and efficiency.
• Maintain and monitor data pipelines to support operational and strategic reporting needs.
• Work closely with business stakeholders to understand data needs and collaborate with cross functional teams to troubleshoot issues, and support data-driven decision-making.

Claims Analyst II

Actuary

• lead key pricing and analytics work within a cross-functional team
• develop and monitor predictive models
• evaluate rate adequacy across states and segments
• lead rate indications and pricing studies to inform renewal strategy and multi-state price updates
• assess retention, conversion, and price elasticity
• conduct pre- and post-implementation impact analyses
• recommend course corrections as needed
• support data mapping, exploration and modeling projects
• drive process improvements through data and automation
• provide technical leadership through mentoring, governance, and clear communication to technical and non-technical stakeholders
• present findings and recommendations to senior leadership

Lead Actuarial Analyst

• Investigate and document property claims, including policy review, recorded statements, assigning inspections, updating reserves, preparing or reviewing estimates, and negotiating settlements
• Communicate claim updates and decisions verbally and in writing
• Handle claims in compliance with all applicable regulations and internal processes
• Act as a resource for less experienced staff
• Support catastrophe response as needed, to include potential overtime and deployment
• Any other duties needed to help drive our purpose and fulfill our values

Special Investigator II

Claims Analyst II

Lead Actuarial Analyst

Property Claims Adjuster, Level II