Senior Investigator, Industry Intelligence Investigations

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Senior Investigators are accountable for conducting thorough investigation for suspicious claims assigned to them. They gather evidence (with the assistance of internal and external partners) and are responsible for the claims handling of matters accepted for investigation. They investigate claims for fraud or policy violations and deny or resolve claims as appropriate. They may also recommend the reporting of activity to the appropriate authorities. Senior Investigators handle all aspects of claims adjusting including: initial claim handling, customer contact, making payments when appropriate, dealing with customer complaints as well as claim disposition and resolution where appropriate. This role will include working on joint industry investigations, reviewing and actioning alerts and tips, investigation of Life and Health claims, rings investigations and screening alerted claims and referrals.

KEY ACCOUNTABILITIES

• Complete thorough investigations while being sensitive to and protecting TDI’s culture of client service
• Determine investigation strategy using a combination of inside investigation and cognitive interviews, supported by Investigators (field investigators) as needed
• Conduct joint industry investigations and participate in industry related projects
• Review alerts and tip and complete an investigation as required
• Screen alerted claims to determine if an investigation is required
• Manage routine claim handling activities, including reserving, payments, claim resolution and closure, and work in partnership with other TDI groups (e.g., subrogation, underwriting)
• Prepare investigation reports and formulate conclusions using consequence matrix; share conclusions and recommendations with Group Manager, Fraud
• Consult Group Managers, Fraud, on consequence management and follow escalation procedures for nuanced cases
• Use internal advanced analytics tools to detect, identify, investigate and prevent fraud.
• Notify customers of outcome of investigation and, where appropriate, resolve claims

• 5+ years of claims handling experience ideally in multiple lines of business (Auto PD, Residential, Bodily Injury and Accident Benefits). Consideration will also be given to those with significant expertise in one line of business based on the department’s needs.
• Experience in conducting investigations in SIU
• A demonstrated commitment to fraud investigation through previous SIU referrals/involvement.
• Knowledge of legal processes and evidence collection.
• Minimum college-level working proficiency.

Functional Skills

• Ability to work in advanced analytics systems including data mining programs
• Ability to properly delegate investigative tasks to Investigators for optimal use of resources
• Expert knowledge of Insurance products, systems, policies and procedures and Insurance Act and the principles of casualty, accident benefit, residential and/or automobile physical damage insurance
• Ability to professionally and tactfully handle difficult conversations and confrontation
• Enrolment in the CIP program and completion of the Principles & Practices course is an asset

KNOWLEDGE AND SKILLS

Emotional Intelligence Expert
Impact and Influence Expert
Delegation Knowledgeable
Continuous Improvement Process Mgmt./Improvement Expert
Insurance Expert
Time Management/ Planning & Organizing Balance Stakeholder Needs Expert
Communicating with external entities such as law enforcement, IBC, Collision Reporting Centres Knowledgeable

Licensing
Provincial licensing may be required

Education
Post-secondary education or equivalent work experience

This position requires proficiency in a language other than French to support customers, employees or markets located outside the province of Quebec or who require services in a language other than French.

This position currently reflects a hybrid model requiring a successful candidate to come into the office twice a week, which is subject to change in the future.

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At TD, we are committed to fostering an inclusive, accessible environment, where all employees and customers feel valued, respected and supported. We are dedicated to building a workforce that reflects the diversity of our customers and communities in which we live and serve. If you require an accommodation for the recruitment/interview process (including alternate formats of materials, or accessible meeting rooms or other accommodation), please let us know and we will work with you to meet your needs.