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Investigative Advisors are accountable for conducting thorough investigation for suspicious claims assigned to them. They gather evidence (with the assistance of SIU Investigators) and are responsible for the claims handling of matters accepted for investigation by the Group Managers, Fraud. They investigate claims for fraud or policy violations and deny or resolve claims as appropriate. They may also recommend the reporting of activity to the appropriate authorities. Investigative Advisors handle all aspects of claims adjusting including: initial claim handling, customer contact, making payments when appropriate, dealing with customer complaints as well as claim disposition and resolution where appropriate.
- Notify customers of outcome of investigation and, where appropriate, resolve claims.
- Manage routine claim handling activities, including reserving, payments, claim resolution and closure, and work in partnership with other TDI groups (e.g., subrogation, underwriting)
- Prepare investigation reports and formulate conclusions using consequence matrix; share conclusions and recommendations with Group Manager, Fraud
- Complete thorough investigations while being sensitive to and protecting TDI’s culture of client service
- Determine investigation strategy using a combination of inside investigation and cognitive interviews, supported by Investigators (field investigators) as needed
- Consult Group Managers, Fraud, on consequence management and follow escalation procedures for nuanced cases
- Use internal advanced analytics tools to detect, identify, investigate and prevent fraud.
- Ability to properly delegate investigative tasks to Investigators for optimal use of resources
- Expert knowledge of Insurance products, systems, policies and procedures and Insurance Act and associated legislation
- Superior knowledge of the principles of casualty, accident benefit, residential and/or automobile physical damage insurance, and associated claims adjustment processes/procedures
- Precision and attention to detail
- Practiced in active listening and summarizing evidence and analytical assessments in order to provide solid and supportable conclusions/actions
- 5+ years of claims handling experience ideally in multiple lines of business (Auto PD, Residential, Bodily Injury and Accident Benefits).
- Consideration will also be given to those with significant expertise in one line of business based on the department’s needs.
- A demonstrated commitment to fraud investigation through previous SIU referrals/involvement.
- Knowledge of legal processes and evidence collection.
- Minimum college-level working proficiency.
- Functional Skills
- Ability to work in advanced analytics systems including data mining programs
Company: TD Bank
Vacancy Type: Full Time
Job Location: Calgary, Alberta, CA
Application Deadline: N/A