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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in leading and developing teams of Investigation Analysts while employing strong investigative judgment and analytical skills to navigate complex investigations. Proficient in managing fraud detection processes and fostering collaborative relationships with stakeholders.
Highest-signal resume keywords
Team LeadershipFraud Investigation MethodologyData Analytics for Fraud DetectionStrong Communication SkillsCritical Thinking and Problem-Solving
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Investigation Strategy DevelopmentEvidence AssessmentDocumenting FindingsConducting InterviewsInsurance InvestigationsFraud Risk IdentificationAnalytical SkillsCase DevelopmentInvestigative JudgmentCoaching and Mentoring
Soft Skills
Relationship BuildingCollaborationOrganizational SkillsConstructive FeedbackTrust Building
Certifications & Qualifications
Fraud Investigation TrainingProfessional Designation in Fraud or Investigation
Industry Keywords
Health ClaimsDental ClaimsProvider PracticesFraud RisksComplex Investigations
About the role
Key responsibilities & impact- Lead, coach, and develop a team of Investigation Analysts
- Provide investigative guidance on complex, sensitive, or higher-risk files
- Develop investigation strategy, assess evidence, document findings, and recommend outcomes
- Promote consistent, high-quality investigative practices
- Support analysts in navigating challenging files and reaching well-supported conclusions
- Identify emerging fraud risks, trends, and investigative opportunities
- Collaborate with internal partners to determine appropriate responses
- Build relationships with business partners and stakeholders
- Support continuous improvement of investigative processes, tools, controls, and practices
- Contribute to a positive, inclusive, and high-performing team environment
- Support employee development and capability growth
Requirements
What you’ll need- Experience with dental, drug, health benefits, or provider investigations
- Knowledge of health and dental claims, provider practices, or related fraud risks
- Previous experience in an informal or formal leadership capacity, including mentoring, coaching, leading complex investigations, or acting as a subject-matter expert
- Experience using data and analytics to support fraud detection or investigations
- Fraud or investigation-related education, training, or professional designation
- Demonstrated experience conducting insurance investigations, with a strong understanding of investigative methodology and case development
- Experience managing complex investigations, including gathering and assessing evidence, conducting interviews, documenting findings, and developing well-supported conclusions and recommendations
- Strong investigative judgment, critical thinking, problem-solving, and analytical skills
- Demonstrated aptitude for people leadership, including the ability to coach, influence, provide constructive feedback, build trust, and support the development of others
- Strong written and verbal communication skills, including the ability to clearly articulate investigative findings, rationale, and recommendations
- Ability to collaborate effectively with a variety of stakeholders and navigate sensitive or complex matters with sound judgment and discretion
- Strong organizational skills with the ability to manage competing priorities while supporting the day-to-day needs of a team
Benefits
Comp & perks- Flexible work environment
- Health insurance
- Dental insurance
- Mental health benefits
- Vision insurance
- Short- and long-term disability insurance
- Life and AD&D insurance coverage
- Adoption/surrogacy benefits
- Wellness benefits
- Employee/family assistance plans
- Retirement savings plans
- Pension
- Global share ownership plan with employer matching contributions
- Financial education and counseling resources
- Paid holidays
- Vacation
- Personal days
- Sick days
- Statutory leaves of absence
- Learning and career growth support
- Inclusive workplace
- Incentive programs and incentive compensation tied to business and individual performance