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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in conducting claims audits and investigations, ensuring compliance with legal and regulatory standards while effectively communicating findings to stakeholders. Proficient in data analysis and report preparation to support claims validity assessments and fraud prevention strategies.
Highest-signal resume keywords
Claims AuditsFraud DetectionData AnalysisReport PreparationCertified Fraud Examiner
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims Process IntegrityDocumentation ReviewData CollectionAnalytical SkillsInterviewing SkillsClaims Validity AssessmentAudit DocumentationFraud Prevention StrategiesComprehensive ReportingRegulatory Knowledge
Soft Skills
Attention to DetailCommunication SkillsCustomer ServiceOrganizational SkillsTeam Collaboration
Certifications & Qualifications
Certified Fraud Examiner
Industry Keywords
Claims ManagementFraud InvestigationAudit ProcessesLegal ComplianceRegulatory Requirements
About the role
Key responsibilities & impact- Ensure the integrity and accuracy of claims processes and protocols
- Collect data for audits and investigations into claims
- Review documentation and interview involved parties
- Identify fraud, waste, abuse, and discrepancies in claims submissions
- Analyze data to assess claims validity
- Recommend claim resolution and closure to management
- Document and input findings
- Conduct impartial audits and investigations from start to closure
- Address customer inquiries and concerns and escalate matters as needed
- Compile organized audit and investigation records
- Create and implement strategies to identify and prevent fraudulent activities
- Communicate with internal teams to process audits and investigations properly
- Communicate findings and updates to customers, claimants, and stakeholders
- Assist with training and supporting other auditors/investigators
- Plan and arrange own work while working with a manager to prioritize projects
Requirements
What you’ll need- Minimum Bachelor's Degree required; education can be substituted for experience
- 2–4 years of experience required; 5–7 years preferred
- Certified Fraud Examiner preferred
- Ability to conduct claims audits and investigations from start to closure
- Analytical skills and attention to detail
- Ability to review documentation and analyze claims data
- Ability to interview witnesses, claimants, and stakeholders
- Knowledge of legal, regulatory, and industry requirements
- Ability to prepare comprehensive reports for legal or audit/investigative purposes
- Ability to communicate with customers, claimants, internal teams, and other stakeholders
Benefits
Comp & perks- Employment offers contingent upon successful completion of pre-employment background and drug screens
- Equal Opportunity Employer
- Drug-free workplace