FraudTriageSpecialist(Mobile)

## Accountabilities Review and process claims with identified risk indicators, conducting detailed analysis to detect potential fraud patterns and anomalies. Collaborate with Special Investigations Unit (SIU) investigators and support fraud referrals, callbacks, and escalation processes when necessary. Research and respond to internal inquiries, ensuring accurate documentation and timely communication across stakeholders and customers. Analyze data and off-system information sources to identify trends, emerging risks, and fraud indicators. Maintain compliance with fraud detection protocols, reporting standards, and risk management policies across all assigned work queues. Identify recurring issue patterns and escalate findings to leadership for further action and process improvement. Support the development and implementation of fraud detection tools, workflows, and preventive measures. Participate in operational meetings to provide feedback, align on performance, and contribute to process enhancements. Provide guidance to team members on fraud detection best practices and case handling procedures. Complete post-decision tasks such as updating BOLOs, risk flags, and negative lists in system databases. Ensure adherence to productivity, quality, and accuracy standards across all claim reviews and fraud assessments. Requirements High school diploma or GED required; additional education (associate degree or higher) preferred. 3+ years of experience in a customer service, claims, insurance, or risk-related environment. Strong analytical and problem-solving skills, with experience working with data or statistical analysis. Ability to obtain and maintain an Insurance Adjuster License, including completion of required coursework and continuing education. Proficiency in Microsoft Office applications (Word, Excel, Outlook) and ability to work across multiple systems and platforms. Strong written and verbal communication skills with the ability to clearly document and present