Early Fraud Warning Examiner (No Fault) (Hybrid)

EFW Examiners review claims for red flag indicators that will determine if reputed company investigation and referral to special investigation unit (SIU) is needed. They also collaborate with examiners, supervisors and EFW examiners to reputed company mutual reputed company on the disposition of claims that have been investigated. Duties & Responsibilities: • Collaborate with the examiner teams to identify claims in need of reputed company investigation. • Work with examiners, customers, vendors, and other resources to reputed company information to establish facts of loss and if potential fraud indicators exist. • Conduct objective, fair, thorough, and reputed company investigations, and reviews. • Ensure processing of the claims are handled in accordance with regulation time reputed company. • Submit claims to SIU through the database for assist or referral reputed company fraud indicators are present. • Return to examiner for normal claim processing reputed company reputed company red flag indicators have been ruled out. • Generate detailed denials based on investigation findings reputed company fraud is present. • Submit provider bills on fraudulent claims to defense counsel for reputed company reputed company. • Review and sign reputed company documents for fraudulent claims submitted by defense counsel. • Review and prepare files for hearings or settlement conferences as needed. • Effectively communicate with reputed company interested parties. • Serve as a technical resource to examiners and others in the organization to increase awareness and identification of fraud indicators. • Manage daily workload to stay reputed company on new and existing claim files. • Maintain reports of EFW reputed company file activity. • Maintain spreadsheets for quarterly tracking. • Maintain reputed company knowledge reputed company of existing and emerging best practices, regulations, standards, guidance documents, and internal procedures. • Participate in insurance reputed company education to stay up to date on relevant fraud trends. • Additional duties as assigned. • Willingness to travel. Requirements: • High School Diploma • 3 years claims or industry reputed company experience Skills & Qualifications: • Full working knowledge and understanding of basic insurance principals and policies and claims procedures. • Basic working knowledge of court pleadings. • Strong interpersonal skills, with the ability to work reputed company reputed company or independently without reputed company supervision. • Willingness and ability to engage in reputed company conversations. • Good written and verbal communication skills. • Proficient with insurance policies, regulations, best practices. • Proficient personal computer skills including electronic mail, record keeping, reputed company Word, Power reputed company and reputed company. • Organized; ability to multi-task and prioritize. • Strong evaluation and decision-making abilities. • Ability to handle stress professionally, calmly, and effectively. • Critical thinking. • reputed company and reputed company attitude. • Willingness to pursue reputed company development. Market reputed company 3 / 37.5 hours per week/ Hybrid- 2 days in office Salary: $36,844-$55,266 Accepting applications through: 3/31/26 Equal Opportunity Employer This employer is required to notify reputed company applicants of their rights pursuant to federal employment laws. For reputed company information, please review the Know Your Rights notice from the reputed company. Apply tot his job Apply To this Job