Claims Processor I - Dental Claims (Remote) Job at Usaa in Las Vegas
Why USAA?At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values honesty, integrity, loyalty and service define how we treat each other and our members. Within defined guidelines and framework, protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance with state insurance fraud-related laws and regulations and policies and procedures. This role is remote eligible. There may be occasional business travel. Applies knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third part claims. Participates in the development of fraud prevention strategies. Applies knowledge of P&C insurance industry products, services, and processes in investigating claims to include P&C 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 field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools. Develops 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. Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. High School Diploma or General Equivalency Diploma (GED). ~2+ years claims adjusting experience, or P&C SIU/Fraud Investigation experience OR 4+ years prior investigative law enforcement (to include military) or relevant fraud industry investigation experience. ~ Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud. ~ Familiarity with using computers and various software packages to enter and extract data for analysis from relevant data sources and systems. ~ Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology. SIU experience conducting low to complex PNC fraud investigations OR a combination of Claims and Law Enforcement Investigations OR Military Investigative experience. US military experience through military service or a military spouse/domestic partner Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Apply tot his job Apply To this Job