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Claims Integrity & Loss Control Specialist
Claims Integrity & Loss Control Specialist
Job Description
Title: Claims Integrity & Loss Control Specialist
Reports to: Claims Manager
Department: Operations
Direct Reports: No
Exempt Status: Non-Exempt
Position Type: Full-Time, Hybrid Schedule
Claims Hours of Operation: Monday – Friday, 7 am – 7 pm, Saturday, 8 am – 3:30 pm
Job Purpose
The Claims Integrity & Loss Control Specialist is responsible for protecting the company and its clients from fraudulent activity, claim leakage, and policy non-compliance. This role proactively identifies suspicious claim activity by auditing repair submissions, analyzing trends, and partnering with internal leadership to safeguard financial performance and operational integrity. This position plays a critical role in maintaining strong loss ratios while supporting fair and accurate claim handling practices.
Reports to: Claims Manager
Department: Operations
Direct Reports: No
Exempt Status: Non-Exempt
Position Type: Full-Time, Hybrid Schedule
Claims Hours of Operation: Monday – Friday, 7 am – 7 pm, Saturday, 8 am – 3:30 pm
Job Purpose
The Claims Integrity & Loss Control Specialist is responsible for protecting the company and its clients from fraudulent activity, claim leakage, and policy non-compliance. This role proactively identifies suspicious claim activity by auditing repair submissions, analyzing trends, and partnering with internal leadership to safeguard financial performance and operational integrity. This position plays a critical role in maintaining strong loss ratios while supporting fair and accurate claim handling practices.
Essential Job Functions
- Maintain industry awareness and education specific to loss control and fraud prevention, ensuring that appropriate strategies are deployed at RoadVantage
- Use individual case studies to derive novel approaches to leveraging data to monitor fraudulent activity
- Analyze claims to identify irregular patterns or high-risk indicators, including duplicate submissions, unsupported repairs, estimate inconsistencies, or potential conflicts of interest.
- Identify patterns of high-frequency claims or abnormal repair behavior.
- Perform detailed audits of technician, dealer, and customer-submitted repair claims.
- Verify validity of repairs against contract coverage, documentation standards, and internal policies.
- Identify claim leakage, improper approvals, or process inconsistencies.
- Analyze data to detect irregular repair patterns or financial discrepancies.
- Provide insights and recommendations to leadership to mitigate loss exposure.
- Maintain thorough documentation and prepare reports summarizing findings, trends, financial impact, and legal support as needed.
- Ensure adherence to company claim procedures.
- Reinforce documentation requirements, photo policies, and approval protocols.
- Partner with supervisors to address non-compliant behavior.
- Work with adjusters, leadership, Sales, and Risk to resolve flagged customers or dealers.
Minimum Qualifications
- 3+ years of claims handling, auditing, risk management, or investigative experience.
- Strong understanding of contract coverage and claim adjudication practices.
- Analytical mindset with experience working with raw data to identify trends.
- High attention to detail with strong documentation skills.
- Ability to manage sensitive investigations with discretion and professionalism.
- Strong communication and cross-functional collaboration skills.
- Proficiency in data entry and Microsoft Office Suite (Excel, Outlook, Word)
- Experience with and comfort using an analytics tool (e.g. Looker, Tableau, Sigma)
- Experience in working with data obtained from a relational database and an understanding of how that data is connected
The information contained herein is not intended to be an all-inclusive list of the duties and responsibilities of the job, nor are they intended to be an all-inclusive list of the skills and abilities required to do the job. Management may, at its discretion, assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.
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