Head of Major Case Investigations - Insurance Fraud (Hiring Immediately)

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values honesty, integrity, loyalty and service define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity We are seeking a dedicated Director Special Investigations Unit Specialty (Major Case) This role is remote eligible, however, individuals residing within a 60-mile radius of a USAA office will be expected to work on-site four days per week. What you'll do: Responsible for the Claims fraud investigation strategy, program management, regional management of investigative staff and the results achieved. Develops investigative and other operational priorities, manages workload balance, develops staffing strategies, and evaluates operational results. Ensures compliance with policies and procedures contributing to fraud control objectives, as well as compliance with state insurance fraud-related laws and regulations.

• Develops investigative and other operational priorities, manages workload balance, develops staffing strategies, and evaluates operational results.
• Creates and maintains industry and other business relationships.
• Directs claims investigative teams, ensures business performance and progress towards short- and long-term objectives.
• Develops and implements Claims Security operational plans/policies in conjunction with senior leadership.
• Consults with senior leadership on strategic direction for SIU.
• Identifies emerging trends and develops new investigation programs and processes.
• Responsible for communication and training tactics in support of new programs and processes.
• Regularly interacts with and influences peers and executive management on significant operational issues.
• Responsible for measuring and reporting on business outcomes for SIU strategy.
• Develops collaborative internal and external relationships with enterprise business partners, vendors, and industry groups.
• Coordinates Claims Security Quality Assurance program.
• Responsible for hiring, employee development, coaching, counseling, performance evaluation and all leadership and management related functions.
• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

What you have:

• Bachelors degree; OR 4 years of related experience (in addition to the minimum years of experience required) may be substituted in lieu of degree (12 years of experience in lieu of a degree).
• 8 years of progressive related (i.e., claims, law enforcement, etc.) or 6 years of P&C experience plus military service experience.
• 3 years of direct team lead or management experience.
• Demonstrated team leadership, cross-functional collaboration, building business solutions, and/or claims/investigation accountabilities.
• Experience using, interpreting, solutioning and leading with data.
• Proficiency at investigative protocols and procedures that would include compliant claims or fraud investigations to the specific state and regulatory requirements.
• Possess in-depth knowledge of insurance policies and broad understanding of procedures related to SIU investigations.
• Capability to analyze data, conduct root causes analysis, identify root causes, and recommend action plans and strategies to overcome operational obstacles and achieve strategic targets
• Ability to act as a subject matter expert to the claims organization to provide guidance and advice on a wide range of fraud related risk and communicating effective courses of action.
• Skilled at presenting business recommendations in a professional format.

What sets you apart:

• Demonstrated skill and history investigating medical cases, including 1st party (PIP), 3rd party (BI), Uninsured Motorist (UM), Chiropractors, Pain Management, DME, Pharmacracy, hospitals, emergency services.
• Demonstrated skill and history investigating property cases, including roofing, water mitigation, hail, flooding, fires/arson.
• Demonstrated skill and history investigating auto property cases, including body shops, glass, towing, salvage issues, staged accidents, enhanced damages.
• Demonstrated skill and history managing Major Case Teams
• Demonstrated skill and history managing Affirmative Litigation cases/ projects, including supporting discovery, managing legal expense, testifying as a corporate witness (PMK, 30(B)(6))
• Demonstrated skill and history interfacing with Senior Executive Management and advocating for MCU program resources.

Compensation: The compensation range for this role is $127,310-$243,340. Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com. Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Apply tot his job Apply To this Job