Senior Fraud Analyst – Long-Term Care Insurance

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. 

Job Summary

As a Senior Fraud Analyst, you will collaborate with Long Term Care (LTC) leadership team and will play a critical role in protecting the organization from fraud, waste and abuse. In this role, you will lead efforts to identify, investigate, and mitigate fraud, waste, and abuse by conducting in-depth investigations, analyzing data, and preparing detailed reports with actionable recommendations. You will also coordinate with internal teams, investigative vendors, Third Party Administrators (TPAs), and regulatory agencies to ensure compliance with reporting protocols. Operating with broad authority, you will manage complex assignments and serve as a subject matter expert in LTC fraud prevention and mitigation.

JOB DESCRIPTION:

Essential Duties & Responsibilities

Performs a combination of duties in accordance with departmental guidelines:

• Partners with Operations, Claims, and Finance leadership, as well as internal SIU, Legal and Compliance to support strategic initiatives.

• Analyzes operations and other data using problem solving and decision making to prepare and present reports to management; including recommendations on policies and procedures, and operational improvements or corrective action plans.

• Utilizes work management tools to efficiently manage caseloads and ensure performance and quality measures are achieved.

• Represents the functional area in meetings with management and other business units as required.

• Oversees project-related expenses, ensuring alignment with budget goals and financial targets.

• Supports management as an agent of change, building collaboration and commitment using innovative ideas and business acumen.

• Works with other departments and may provide technical guidance to others within the department.

• Supports LTC anti-fraud initiatives through data analytics by partnering with business leaders in identifying opportunities to build and analyze metrics through data visualizations, leveraging tools such as Google Cloud Platform, Looker, Power BI and other advanced data tools.

• Shares knowledge and collaborates across functional or geographic areas to share and incorporate learnings to improve business results and to ensure consistency, process, and outcomes.

• Continuously learns more and stays up to date in functional area of expertise and industry activity and trends. May participate in industry trade groups.

• Collaborates with management, technical staff and subject matter advisors to understand business needs/issues, troubleshoot problems, conduct root cause analysis and develop cost effective resolutions to improve operational efficiency.

• May be responsible for special projects and presentations.

May perform additional duties as assigned.

Reporting Relationship

Manager or above

Skills, Knowledge & Abilities

• Knowledge of industry practices, company operations and departmental functions.

• Excellent organizational and project management skills, with the ability to prioritize and coordinate multiple initiatives.

• Proficient in drafting demand letters, and interpreting policy language.

• Skilled in handling challenging conversations and negotiating favorable outcomes.

• Strong interpersonal, analytical, problem solving, verbal and written communication skills with the ability to present insights effectively across all levels of the organization.

• Proven ability to work independently and collaboratively, fostering solid relationships with internal and external partners

• Ability to exercise professional judgement and assume responsibility for decisions which have an impact on people, costs and quality of service.

• Advanced proficiency in Excel and solid working knowledge of Microsoft Office Suite; familiarity with tools like Tableau, Looker, BigQuery, and other business intelligence platforms is a plus.

• Ability to translate complex data into compelling narratives and actionable insights through effective reporting and presentations.

Education & Experience

• Bachelor's Degree or equivalent work experience and completion of applicable professional designations.

• Typically three to five years relevant professional experience.

• Knowledge of Fraud in insurance operations preferred, especially long-term care.

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In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees – and their family members – achieve their physical, financial, emotional and social wellbeing goals.  For a detailed look at CNA’s benefits, please visit cnabenefits.com.

CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact leaveadministration@cna.com.