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Dir, Special Investigation Unit

The Company:  Aflac Columbus
The Location: 

Columbus, GA, US, 31999

The Division:  Compliance
Job Id:  2803

Job Summary

Effectively plans and directs the delivery of fraud investigations involving internal employees, agents and customers; manages the gathering and analysis/interpretation of data pertaining to fraudulent activity; reviews problem areas and provides the strategic vision for swift resolution and proactive prevention for the future, develops mitigation strategies, and assists in the implementation of actions to resolve problems; directs mandatory reporting of fraudulent activity to the appropriate department of insurance, local, state, and federal law enforcement agencies

 

Principal Duties & Responsibilities 

  • Directs the interpretation of data and reports pertaining to the overall operation of the Special Investigation Unit and the completion of reports summarizing activities and trends; directs the independent review of problem situations, development of solutions, and implementation of action plans to resolve challenges and ensure customer satisfaction; develops and reviews processes and procedures to streamline activities to enhance service turnaround time, productivity, and quality 
  • Works closely with the Director, Aflac Trust to assist with the identification and prioritization of fraud risks within the organization based on industry trends as well as Aflac’s operational environment, prior fraud activity, and the internal control structure 
  • Reviews, stays abreast of, and maintains an understanding of state and federal insurance statutes, regulations, and internal policies to ensure compliance 
  • Evaluates the training efforts of the Special Investigation Unit to ensure that the necessary educational tools are provided to employees; partners with corporate training and other business unit resources to identify and communicate training needs. Oversees implementation of required antifraud training 
  • Coaches, mentors, trains and transfers knowledge to others within the SIU and related departments; Solicits innovative ideas for potential fraud recognition, referrals and investigations to improve the department’s and the corporation’s performance 
  • Evaluates business technology requirements and enhancement possibilities; recommends viable technological solutions, modification, and applications to support anti-fraud efforts; Facilitates effective communication with the various Departments of Insurance 
  • Performs other duties as required

 

Education & Experience Required

  • Minimum Required Bachelor's Degree criminal justice, business administration, business management, or a related field
  • Minimum Required 10 years of professional job related work experience, 5 years management experience

 

Education & Experience Preferred

  • Preferred Designation/certification in one or more of the following: Certified Fraud Examiner (CFE), Fraud Claims Law Specialist (FCLS), Health Care Anti-Fraud Associate (HCAFA), Certified Insurance Fraud Investigator (CIFI) (strongly preferred) Certification in Lean and/or Six Sigma

 

Or an equivalent combination of education and experience.

 

Job Knowledge & Skills 

  • Broad knowledge of fraud as it relates to the insurance business; understanding and experience with market conduct examinations 
  • Understanding and experience working with and communicating with Departments of Insurance (DOIs) 
  • Ability to balance diplomacy, tact and sensitivity with the necessary diligence, persistence and tenacity required to thoroughly investigate and report on business operations, conduct and actions that may prove to be abusive or fraudulent in nature 
  • Ability to capture and analyze significant amounts of data from a variety of diverse and disparate IT systems, platforms, databases and infrastructures
  • Excellent presentation, oral, written, and interpersonal communication skills to effectively interact with all levels of management, internal and external customers, and agency representatives collecting or providing information; Ability to facilitate discovery events and categorize, prioritize, quantify and document results 
  • Ability and willingness to travel

 

Competencies 

  • Acting with Integrity 
  • Communicating Effectively 
  • Pursuing Self-Development 
  • Serving Customers 
  • Supporting Change 
  • Supporting Organizational Goals 
  • Working with Diverse Populations 

 

Director Competencies 

  • Acting as a Champion for Change 
  • Developing Talent 
  • Managing Performance 
  • Navigating Organizations 
  • Setting Objectives 

 

Working Conditions

The statements below describe the general nature and level of the work and are not an exhaustive list of all responsibilities, duties, and skills required.

Normal office environment (virtual or in-person)

 

Travel

≤ 10%


Nearest Major Market: Columbus GA