Job Description

Creates and maintains an ongoing awareness on the part of all claim file handlers toward recognition of "red flags" in claim cases, leading to the detection, investigation and mitigation of potentially fraudulent and/or inflated claims. Performs a variety of duties and responsibilities to bring about resolution, compromise, denial and/or prosecution of fraudulent claims. Is accountable for controlling costs for contracted activities.

The ideal candidate's preferred location is in Eastern Pennsylvania, with travel required throughout the state and others.

What You’ll Do:

As a Special Investigator Sr with Sentry, you will create and maintain an ongoing awareness on the part of all claim file handlers toward recognition of suspect behavior in claims cases, leading to the detection and resolution of potentially suspect/inflated claims. In addition, you will…

• Investigate moderate to complex claims both inside and outside the office, to identify suspect or inflated claims across all lines of business.
• Conduct scene investigations, take recorded statements, and assigning independent contractors as needed.
• Compile and analyze data and information on claims, from various sources, and verify legitimacy of documents as necessary.
• Maintain detailed investigation information within the SIU case management and claims systems, preparing summary reports to capture findings and recommending course of action to management, which may include referring to law enforcement.
• Develop and conducts anti-fraud awareness training for internal and external stakeholders to support the organizations risk management program and meet state mandated requirements.
• Serve as a representative/liaison between the company and industry and law enforcement fraud agencies to obtain assistance in conducting investigations.
• Have in depth knowledge of ICD9 and CPT coding in applicable PIP states
• Use experience in clinic inspections
• Demonstrate superior statement/EUO skill sets

What it Takes:

• Bachelors degree or equivalent work experience, degree in Police Science, Police Administration, Criminal justice, or an equivalent field preferred
• 5+ years of related work experience
• Experience in some aspect of law enforcement, claims handling, and/or criminal investigation preferred
• Proficient and effective use of various computer software applications and the ability to adapt to new technologies when introduced
• Strong investigative skills along with ability to work effectively with members of the claims staff and the law enforcement community
• Strong written and oral communication skills and the creativity to recognize potential fraud and develop a reasonable plan for investigating potentially suspect cases

What You'll Receive:

At Sentry, your total rewards go beyond competitive compensation. Below are some benefits and perks that you’ll receive.

• Sentry is happy to offer flexibility through a scheduled Hybrid work model. Monday and Friday work from home if you choose to, Tuesday through Thursday you’ll work in office.
• As a Sentry associate, you will have an in-office workspace and materials for your home office. In addition to the laptop, you will receive prior to your start, Sentry will provide equipment for your home office. 
• Meal Subsidy available for associates who report to an office.
• 401(K) plan with a dollar for dollar match on your first eight percent , plus immediate vesting to help strengthen your financial future.
• Continue your education and career development through Sentry University (SentryU) and utilize our Tuition Reimbursement program
• Generous Paid-Time Off plan for you to enjoy time out of the office as well as Volunteer-Time off
• Group Medical, Dental, Vision, Life insurance, Parental leave, and our Health and Wellness benefits to encourage a healthy lifestyle.
• Well-being and Employee Assistance programs
• Sentry Foundation gift matching program to encourage charitable giving.

About Sentry:

We take great pride in making Forbes’ list of America’s Best Midsize Employers. A lot of different factors go into that honor, many of which contribute to your job satisfaction.

Our bright future is built on a long track record of success. We got our start in 1904 and have been helping businesses succeed and protect their futures ever since. Because of the trust placed in us, we’re one of the largest and financially strongest mutual insurance companies in the United States. We’re rated A+ by A.M. Best, the industry's leading rating authority.

Our headquarters is in Stevens Point, Wisconsin, with offices located throughout the United States. From sales to claims, and information technology to marketing, we enjoy a rewarding and challenging work environment with opportunities for ongoing professional development and growth.

Get ready to own your future at Sentry. Opportunities await!

Joe Larsen

Talent Acquisition Specialist

Joe.larsen@sentry.com

Equal Employment Opportunity

Sentry is an Equal Opportunity Employer. It is our policy that there be no discrimination in employment based on race, color, national origin, religion, sex, disability, age, marital status, or sexual orientation.

Job Tags

For contractors, Work experience placement, Immediate start, Work from home, Home office, Monday to Friday,

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