Skyward Specialty Insurance

Manager

• Overseeing the company’s fraud detection, subrogation, and recovery functions
• Coordinating all potential fraud investigations and ensuring compliance with state-level SIU reporting requirements
• Using traditional and AI-based fraud detection indicators and other investigative tools
• Partnering with adjusters and claims managers to evaluate concerns, determine appropriate investigative strategies, and assign cases to third-party vendors
• Reviewing and interpreting claims data and data from third-party vendors to make recommendations for improvements in investigations, processes and outcomes
• Using ISO data and predictive models to proactively conduct and/or facilitate additional investigation on claims
• Assigning investigative fieldwork to third-party vendors and overseeing vendor performance, quality, and compliance
• Completing and/or contributing state-level SIU statistical reporting functions in conjunction with compliance department personnel
• Providing consultative support to claims staff regarding fraud detection, subrogation, and recovery opportunities
• Reviewing vendor investigative findings and preparing or validating reports summarizing conclusions and recommendations
• Coordinating with legal, compliance, underwriting, and law enforcement/regulatory agencies when necessary
• Developing and facilitating training and awareness initiatives to strengthen fraud prevention capabilities across the claims team
• Seeking out new vendors with insightful data sources and technology solutions that help identify fraud or questionable claim indicators
• Performing other duties as assigned.

Manager, Special Investigations – Recovery

Auditor

• Conduct thorough audits of accident and health insurance claims to verify accuracy, policy compliance, and proper adjudication.
• Ensure claims adhere to company policies, industry regulations, and legal requirements, including HIPAA.
• Analyze claims data to identify patterns, discrepancies, and opportunities for process improvement.
• Prepare detailed audit reports and communicate findings, recommendations, and corrective actions to management and relevant departments.
• Collaborate with claims processing teams to implement audit recommendations, streamline workflows, and enhance claims accuracy.
• Serve as a subject matter expert by training junior auditors and claims processors on audit procedures and compliance standards.
• Maintain accurate documentation of audit processes, findings, and follow-up actions, ensuring all information is safeguarded and confidential.
• Stay updated on changing regulations, industry best practices, and emerging audit methodologies.

Claims Auditor – Medical Stop Loss

Underwriter

• Provide timely, efficient, and accurate support to Underwriting with respect to issuing policies
• Create policy documents which represent the insurance transaction bound by the underwriter
• Ensure statistical coding and policy issuance complies with regulatory requirements
• Maintain electronic and/or physical underwriting file
• Solicit renewal transactions
• Provide operational support for the product line’s underwriters
• Work with the unit underwriters to bind, book, and issue policies
• Review policies for accuracy and regulatory standards
• Input policy and underwriting data in appropriate systems
• Make direct contact with brokers and their assistants

Manager, Special Investigations – Recovery

Claims Auditor – Medical Stop Loss

Underwriting Assistant – Energy