Director - SIU Claims
Scottsdale , Arizona
January 27, 2017
Nationwide Insurance is Hiring a Director - SIU Claims to sit in either Denver, CO orScottsdale, AZ. The Ideal Candidate will have the following: Claims, Product, or Underwriting experience; Management experience overseeing a team; Strategic Agility; Outstanding communication skills; and Strong knowledge of technology. Overseeing a remote team and/or SIU experience is a plus.

JOB SUMMARY: Directs the performance of SIU operations. Ensures Enterprise affiliate customer satisfaction. Facilitates and supports loss control objectives; develops and coordinates strategies to maintain and enhance achievement of SIU fraud control objectives; supports Claims Operation by providing expert investigative services and consultation. Reviews and makes recommendations on outcomes of investigations in a prompt and expeditious manner. Provides guidance and recommendations to claims leadership and associates on claims resolution. Promotes and provides "On Your Side" customer service.Ensures that Claims is provided with a timely, quality investigative product to make appropriate decisions involving fraud issues; makes one-on-one observations for performance assessment needed to achieve investigative excellence.RELATIONSHIP: Reports to SIU AVPDIRECT REPORTS:JOB RESPONSIBILITIES:1. Promotes the use of SIU within the Nationwide Insurance Enterprise. Develops and facilitates communication within the industry for identification of significant fraud-related issues.2. Develops and implements fraud recognition and prevention training programs for claims representatives, managers, special investigators, underwriters, and agents.3. Ensures regulatory compliance through filing of fraud plans with the Department of Insurance where required; ensures the notification of the Department of Insurance on suspicious claims where required.4. Serves as corporate representative on industry committee associations established to combat insurance fraud. Creates lines of communication with regulatory agencies, sensitizing them to the insurance fraud problem, solicits assistance in the Nationwide Enterprise effort to control the problem.5. Partner with industry leaders to help promote industry and legislative changes that benefit our stakeholders.6. Monitors automated systems designed to maintain and analyze national insurancefraud related data and statistical information related to Enterprise fraud prevention efforts.7. Coordinates and provides consultation regarding the overall corporate direction of the Nationwide Fraud Control Program. Develops, evaluates and recommends policies, strategies and guidelines for Nationwide regarding insurance fraud issues.8. Exercises decision in the control, coordination, direction and evaluation of SIU operations, including the approval or disapproval of critical investigative actions. Determines, recommends or implements actions necessary to maximize investigative results. Monitors investigative workloads and resources and determines when adjustments are warranted. Assures appropriate coordination and cooperation with internal and external contacts.9. Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective Nationwide customers.10. Resolves customer complaints according to Best Practices. Monitors customer satisfaction in an effort to drive action plans for improvement.11. Projects, prepares and recommends SIU expense budgets; controls expenditures in conformance with approved budgets and approves SIU staff expense accounts. Reviews, evaluates and develops staff performance evaluations.12. Identifies, develops and retains high potential/high performing associates who have the potential for or are ready to fill critical roles in the organization.13. Directs associate management including performance management, salary planning and administration, training and development, workflow and organizational planning, hiring and placement, and disciplinary actions.14. Performs all other duties as assignedJOB REQUIREMENTS:Education: Undergraduate degree or equivalent experience in insurance, law, sociology, criminal justice or business preferred.Licenses/Designations: State licensing where required. Successful completion of required claims certification schools/classes. Fraud Claims Law Specialist or Certified Insurance Fraud Investigator designation highly desirable.Experience: Minimum ten years progressive work experience as an SIU Manager or ten years combined SIU, legal, claims or law enforcement experience. Prior management experience required.Knowledge: In-depth knowledge of the insurance industry, Special Investigation Unit operations and related best practices, claims handling and payment operations, and insurance policies, coverage, and contracts. Thorough knowledge of insurance fraud schemes, indicators, elements, and appropriate legal investigative techniques, specialized resources, contracts, and evidentiary procedural, technical and operational matters associated with insurance fraud detection. Knowledge of legal issues and litigation process. Unfair Claims Practices Act and Legislative Insurance Department Regulatory requirements in regional geographic jurisdictions. State and federal civil and criminal law.Skills/Competencies: Excellent customer focus to proactively identify and understand customer needs. Oral and written communication skills for frequent contact with claims representatives, claimants, policyholders, claims field management.Demonstrated decision-making skills, including the ability to recognize, analyze and improve claims performance situations such as loss control, LAE, customer satisfaction, employee development and engagement. Ability to supervise and train claims representative in all aspects of claims processes. Effective listening, oral and written communication skills necessary for customer contact, negotiation, presentations, project management, personnel management. Ability to make decisions, establish priorities, and set strategic directions. Ability to organize and deal with a variety of situations, discern problems and recommend/implement resolutions. Proven ability to operate personal computer with proficient use of claims and business software.Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.Staffing Exceptions to the above Minimum Job Requirements must be approved by: Business Unit Executive and Human Resources.JOB CONDITIONS:Working Conditions: Normal office environment or remote work environment. Representatives may be required to operate an automobile and have a valid driver's license with a safe driving record. Must be willing to work extended hours and to travel with possible overnight requirements. Must be available to work catastrophes (CAT) requiring travel to CAT sites with multiple on-site responsibilities and/or for extended periods of time. Including holidays and weekends.Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.



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