claims investigator

IWI Services

Job Title: Field Officer (Health Claim Investigator)Location: Gurgaon, HaryanaSalary: 16k to 18k+ 6K (Travel) + InsentiveReporting to: Area Manager (Back Office)Summary of Main Responsibilities: Investigation of health and PA claims:Insured visit, Hospital Visit, Doctor visit, collect evidences of genunity of claim or evidences of fake claims. Collect past medical record from insured, hospital or any other consulting doctor.Zero time reporting with concerned area manager is compulsory for each and every case.Qualification: Graduation in any Stream, Fresher or experience in field only.Bike and android phone is compulsory Please share the resume at hr.iwiservices@gmail.comWhatsApp No. 79 7380 9236Job Type: Full-timePay: &#8377;16,000.00 - &#8377;18,000.00 per monthBenefits:<ul><li>Health insurance</li></ul>Work Location: In person

Field Executive

Maryland Department of Transportation

<div><div><div><div>MVA Investigator</div><div> 
OPEN RECRUITMENT</div><div> 
The Motor Vehicle Administration (MVA) is seeking a dynamic, innovative, and creative candidate with a focus on delivering premier customer service with innovate ideas and solutions to fill the position of MVA Investigator within the Office of Investigative and Security Services.</div><div></div><div> 
</div>
 Responsibilities Include: 
<ul><li>
Conducting investigations of consumer complaints filed against MVA licensed businesses and/or licensed salespersons working for the dealerships</li><li>
Performing covert surveillance, sometimes with the assistance of law enforcement personnel, to obtain evidence of violations</li><li>
Acting as the representative of MVA and the complaining customer in presenting evidence before administrative, state and/or federal courts</li><li>
Enforcing laws pertaining to foreign vehicle registration and motor vehicle insurance compliance</li><li>
Inspecting the area surrounding the curtilage of Marylanders requesting a reserved residential parking space due to a permanent disability and investigating complaints of abuse and/or fraud regarding these reserved spaces</li><li>
Being thoroughly knowledgeable with the Transportation Article and COMAR relating to vehicle dealerships, salespersons, tag and title services, and consumer protection</li><li>
Constructing cases by gathering evidence, writing reports, assisting law enforcement officers, prosecuting attorneys, and the Business Licensing Division of MVA</li><li>
Appearing as a witness when subpoenaed or requested by a competent authority</li><li>
Investigating fraud involving the issuance of driver&rsquo;s licenses, identification cards and vehicle registration</li><li>
Meeting and interviewing drivers who have been referred to the Medical Advisory Board (MAB) and/or the Driver Wellness and Safety Division of MVA and retrieving the driver&rsquo;s licenses of those individuals who have been deemed unsafe to drive by the Medical Advisory Board</li><li>
Providing security escorts to contractors working in MVA branch offices during off hours</li><li>
Filling in, on a reserve basis, as a COVID 19 building protocol screener</li></ul><div>
The current vacancy exists in MDOT MVA&rsquo;s Office of Special Operations in Glen Burnie, MD (Anne Arundel County).</div><div> 
MDOT offers a generous and competitive benefits package.</div><div>
You can learn about our amazing benefits here: MDOT Benefits Guide</div><div>
</div><div>
*Connecting You to Life's Opportunities*</div></div>
<div><h2 class="jobSectionHeader">Qualifications</h2></div>
<div><div>Minimum Qualifications: 
 
Education: Graduation from high school or possession of a high school equivalency certificate. 
 
Experience: Four (4) years of experience conducting investigations in one or a combination of the following areas: claims investigations, law enforcement, security services. 
 
Notes: 
 
1. Additional education at an accredited college or university may be substituted at the rate of thirty (30) credit hours for one (1) year of experience with at least twelve (12) credits in law enforcement or criminal justice.</div></div> 

<div><h2 class="jobSectionHeader">Licenses &amp; Certifications</h2></div>
<div><div>Employees in this classification are assigned duties that require the operation of a motor vehicle. Employees will be required to possess a motor vehicle operator's license valid in the State of Maryland.</div></div></div></div>

MVA Investigator

USAA

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 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. Be part of what truly makes us special and impactful.The OpportunityAs a dedicated Injury Examiner, you will be responsible to adjust complex bodily injury claims, UM/UIM, and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy.This role is remote eligible in the continental U.S. with occasional business travel. However, individuals residing within a 60-mile radius of a USAA office will be expected to work on-site three days per week.What you'll do:<ul><li>Adjusts complex auto bodily injury claims with significant injuries (e.g. traumatic brain injury, disfigurement, fatality) and UM/UIM, and small business claims, as well as some auto physical damage associated with those claims. Identifies, confirms, and makes coverage decisions on complex claims.</li><li>Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes.</li><li>Prioritizes and manages assigned claims workload to keep members and other involved parties informed and provides timely claims status updates.</li><li>Collaborates and supports team members to resolve issues and identifies appropriate matters for escalation.</li><li>Partners and/or directs vendors and internal business partners to facilitate timely claims resolution.</li><li>Serves as a resource for team members on complex claims.</li><li>Delivers a best-in-class member service experience by setting appropriate expectations and providing proactive communication.</li><li>Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours.</li><li>May be assigned CAT deployment travel with minimal notice during designated CATs.</li><li>Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.</li><li>Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.</li></ul>What you have:<ul><li>High School Diploma or General Equivalency Diploma.</li><li>4 years auto claims and injury adjusting experience.</li><li>Advanced knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations.</li><li>Advanced negotiation, investigation, communication, and conflict resolution skills.</li><li>Demonstrated strong time-management and decision-making skills.</li><li>Proven investigatory, prioritizing, multi-tasking, and problem-solving skills.</li><li>Advanced knowledge of human anatomy and medical terminology associated with bodily injury claims.</li><li>Ability to exercise sound financial judgment and discretion in handling insurance claims.</li><li>Advanced knowledge of coverage evaluation, loss assessment, and loss reserving.</li><li>Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.</li></ul>What sets you apart:<ul><li>2 or more years of catastrophic injury experience (e.g. traumatic brain injury, disfigurement, fatality)</li><li>Experience handling UM/UIM injury claims</li><li>College Degree (Bachelor's or higher).</li><li>Insurance Designation.</li></ul>Compensation range: The salary range for this position is: $85,040 - $162,550.USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). 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. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. 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. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. 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.

Injury Examiner

Manulife

<div>Position Responsibilities :
<ul><li>Successfully completes high-quality, sophisticated long term care claims investigations
</li><li>Independently develops and drives a detailed investigative plan
</li><li>Acquires and reviews internal / external documents to support investigative activity and findings
</li><li>Conducts interviews of insureds, caregivers, and other involved parties
</li><li>Handles third party vendor(s) conducting long term care surveillance activities
</li><li>Regularly communicates findings and investigation status to Requesters
</li><li>Produces reports that are accurate and objective
</li><li>Presents case findings and recommendations for further action to department management and Requesters
</li><li>Optimally applies internal case management systems to keep department management updated and to plan / prioritize concurrent assignments
</li><li>Adheres to departmental, company and regulatory timelines, policies, and requirements
</li><li>When applicable, prepares and presents cases for referral to law enforcement, prosecutors, and regulators; provides depositions, grand jury, and court testimony as the need arises
</li><li>Mentors and trains more junior investigators on long term care claim cases and processes
</li><li>Ability to travel on short notice and responds to urgent long term care claim investigations
</li><li>Maintains knowledge of sophisticated investigative techniques, company / external sources of information, changes in the financial services industry as well as applicable laws and regulations impacting long term care claim investigations and other relevant topics
</li><li>Maintains and continuously expands network of professional contacts
</li><li>Plays a major role in the department&rsquo;s fraud awareness training program by developing and delivering appropriate material to employees
</li><li>Attends training sessions, reads pertinent trade journals, actively participates in, and makes presentations to professional organizations and associations
</li></ul>Required Qualifications:
<ul><li>Bachelor&rsquo;s degree preferably in Criminal Justice or related field required; graduate work a plus
</li><li>5+ years of proven track record in the investigation profession and/or financial services industry
</li><li>Designations / certifications in relevant subject matter areas a plus (CFE, LTCP, LOMA)
</li></ul>Preferred Qualifications:
<ul><li>Highly proficient in various computer applications (Microsoft products etc.)
</li><li>Sophisticated written and verbal communication skills
</li><li>Sophisticated analytical skills
</li><li>Sophisticated interviewing skills
</li><li>Ability to work in a dynamic environment
</li><li>Efficient and effective organizational skills
</li><li>Strong presentation skills
</li><li>Foreign language proficiency a plus
</li></ul>When you join our team :
<ul><li>We&rsquo;ll empower you to learn and grow the career you want.
</li><li>We&rsquo;ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.
</li><li>As part of our global team, we&rsquo;ll support you in shaping the future you want to see.
</li></ul>#LI-Remote
 
#LI-JH
About Manulife and John Hancock
Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit https://www.manulife.com/en/about/our-story.html .
Manulife is an Equal Opportunity Employer
At Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.
It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact recruitment@manulife.com .
Referenced Salary Location
USA, New York - Full Time Remote
<div><div><div><div><div><div><div><div><div><div><div><div><div><div>Working Arrangement
</div></div></div></div></div></div></div></div></div></div></div></div></div></div>Remote
Salary range is expected to be between
$90,225.00 USD - $162,405.00 USD
If you are applying for this role outside of the primary location, please contact recruitment@manulife.com for the salary range for your location. The actual salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education/training. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.
Manulife/John Hancock offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&amp;D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans. We also offer eligible employees various retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in the U.S. includes up to 11 paid holidays, 3 personal days, 150 hours of vacation, and 40 hours of sick time (or more where required by law) each year, and we offer the full range of statutory leaves of absence.
Know Your Rights I Family &amp; Medical Leave I Employee Polygraph Protection I Right to Work I E-Verify I Pay Transparency
Company: John Hancock Life Insurance Company (U.S.A.)</div>

Global Investigative & Forensic Services Senior Investigator

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 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. Be part of what truly makes us special and impactful.The OpportunityWe are looking for a number of SIU Investigators (mid-level) in California.This is a desk position. 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. However, you must currently live in California. There may be occasional business travel.What you'll do:<ul><li>Applies knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third part claims.</li><li>Participates in the development of fraud prevention strategies.</li><li>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.</li><li>Applies knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.</li><li>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.</li><li>Makes recommendations within defined authority guidelines.</li><li>Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results of the investigation and recommended outcome.</li><li>Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.</li><li>May serve as a resource team member on specific matters through demonstrated skill or training.</li><li>Assists with the delivery of fraud awareness training initiatives in a defined environment.</li><li>Handles CAT duty responsibilities as business requires.</li><li>Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.</li></ul>What you have:<ul><li>High School Diploma or General Equivalency Diploma (GED).</li><li>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.</li><li>Proven investigatory skills.</li><li>Experience obtaining statements from various parties to incidents, witnesses, and suspects.</li><li>Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.</li><li>Demonstrated ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems.</li><li>Familiarity with using computers and various software packages to enter and extract data for analysis from relevant data sources and systems.</li><li>Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.</li></ul>What sets you apart:<ul><li>SIU experience conducting low to complex PNC fraud investigations OR a combination of Claims and Law Enforcement Investigations OR Military Investigative experience.</li><li>Designations such as CFE, CIFI, SCLA, ACLS, FCLS, LPCS, AIC, CPCU, CCLS, or other.</li><li>US military experience through military service or a military spouse/domestic partner</li></ul>Compensation range: The salary range for this position is: $77,120 - $147,390 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. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. 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. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. 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.

SIU Investigator P&C (Mid-Level)

Braxtone Group

<figure class="table"><table><tbody><tr><td>Main Purpose of Job:&nbsp;&nbsp;The role focuses on handling complex auto assignments and driving business growth by expanding partnerships with insurance companies, with the goal of increasing Braxtone’s market share in the auto claims sector.&nbsp;</td></tr><tr><td>Key Responsibilities:&nbsp;<ul><li>Conducting surveys, vehicle inspection, spot inspection, and investigation by evaluating the claim documents, loss scenarios, and prepare the reports with technical reasoning.</li><li>Scrutinizing the claim documents and the information received from the insurers and the customers.</li><li>Drafting and preparing the survey reports in Arabic and English of the assigned cases in fraud investigation, technical reports, and market value.&nbsp;</li><li>Interacting with the Clients, Client’s Customers, Legal authorities (Insurance Authority, Police Stations, etc), garages &amp; workshops, etc.&nbsp;</li><li>Investigate, Evaluate, and Settle insurance claims.</li><li>First point of contact with the insurer and the customer.</li><li>Contact claimants' customers to obtain written statements and get additional information on questionable claims.</li><li>Preparation of preliminary reports and detailed status reports on all aspects of claims.</li><li>Delivering reports within the TAT and achieving the revenue targets.</li><li>Support, Guide, and Train Motor Claims Surveyors and Back Officers in all loss adjusting and surveys process and requirements.</li><li>Responsible to provide investigation surveys status to client relation officer to update the insurers.&nbsp;</li></ul>&nbsp;&nbsp;Essential Qualifications Required (Education/Experience/Skills)<ul><li>University qualification: A bachelor’s degree / Diploma holder, Automotive or mechanical will be preferred.</li><li>Licensed Loss Adjuster by the insurance Authority in UAE&nbsp;</li><li>Customer service and automobile industry experience is required.</li><li>Insurance related experience is required in UAE Market.</li><li>Insurance qualification will be considered as an asset.</li><li>Must have valid UAE driving license.</li><li>Excellent verbal and written communication skills, knowledge of Arabic (written and spoken)&nbsp;</li></ul>will be considered an asset.<ul><li>Proficient keyboard skills and computer literacy.</li></ul>&nbsp;Competency&nbsp;&nbsp;<ol><li>Motor Vehicle Damage Assessment: Strong ability to inspect and assess damage to vehicles (accident, theft, fire, flood, etc.) and determine the scope of loss.</li><li>Insurance Policy interpretation:&nbsp;Skilled in interpreting motor insurance policies, coverage limits, exclusions, and excess to determine claim validity.</li></ol>&nbsp;Behavioral1.Analytical Thinking: Able to assess complex situations, analyze evidence, and draw logical conclusions.2.Time Management: Effectively manages multiple inspections and reports within given timelines, often under pressure.&nbsp;Targets&nbsp;<ul><li>Achieving SLA and minimize TAT as per the company policy.&nbsp;</li><li>Providing new Clients leads&nbsp;</li><li>Achieving the targeted income and optimal production&nbsp;</li></ul>&nbsp;Typical Working ConditionsNormal Working Hours 40 hours a weekWork may require occasional weekend and/or evening work.&nbsp;</td></tr></tbody></table></figure>

Loss Adjuster  - Consumer Lines

Confidential Company

<ul><li>Conduct on-site and workshop inspections of damaged vehicles to assess the nature, cause, and extent of damage.</li><li>Review accident reports, photographs, repair estimates, and supporting documents submitted by workshops or insured parties.</li><li>Verify coverage, policy conditions, and claim authenticity to detect potential fraud or non-claimable damages.</li><li>Prepare detailed survey reports including technical findings, estimated repair costs, depreciation, and recommended liability.</li><li>Negotiate repair costs and settlements with garages, agencies, and clients to ensure cost control and fairness.</li><li>Liaise with insurance assessors, garages, spare parts suppliers, and internal claims staff for effective claim handling.</li><li>Ensure compliance with company guidelines, insurance laws, and regulatory standards.</li><li>Follow up on pending repairs, re-inspections, and final settlement approvals.</li><li>Maintain accurate records of inspections, photos, and communication for each assigned claim.</li><li>Provide technical advice to claims handlers and underwriters regarding vehicle valuation and repairability.</li></ul>

Motor Claims Surveyor

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