Fraud Claims Analyst

Fraud Claims Analyst – Home Serve USA

Location:

Chattanooga, TN

The Contractor Operations Claims Analyst will be responsible for data analysis, reporting, and auditing to ensure that internal operations teams and Home Serve's third‑party contractor network are administering claims in accordance with policy terms and conditions, processes, and pre‑negotiated rate schedules. The Claims Analyst will utilize claims data and reporting to identify opportunities to improve financial underwriting performance, operational efficiencies, and the customer experience.

The incumbent will work independently and collaboratively across both the Operations and Finance teams to develop analytical reports to better understand opportunities for cost avoidance. The Claims Analyst will conduct ad‑hoc reviews and regular deep dives of identified trends and opportunities, and work with key business stakeholders to provide summaries of findings and recommended actions. This position is onsite and reports to our office in Chattanooga, TN.

• Utilize claims data to identify unfavorable trends or opportunities in claims performance to determine where additional analysis is necessary.
• Conduct audits based on findings to analyze the unfavorable trends impacting business claims performance, and identify and audit any contractors, or internal operations team members not adhering to pre‑negotiated rate schedules, processes, and/or policy terms and conditions.
• Accurately identify, document, and share findings and opportunities for improvement. Create and document action plans for any business process changes identified during audits and assist in guiding the implementation of the changes.
• Develop a clear framework for tracking and monitoring the implementation of business process changes and continually assess the impact of the changes on claims performance.
• Communicate insightful summaries to key business stakeholders on findings along with recommended actions for improvement tailored to the needs of the department.
• Responsible for completing various audits monthly, quarterly, or annually within Contractor Management to remain SOX compliant.
• Keep current on operational processes, contractor rate schedules, repair methods and practices, and policy terms and conditions.
• Build and maintain excellent relationships with key business stakeholders including, but not limited to, Regional Operations Managers, Cost Authorization, Contractor Administration, Repair Management, and Finance.
• Meet KPI targets established by the company.
• Perform other duties as assigned.

• Completing contractor or claims audits to provide actionable feedback to the business and ensure performance & quality goals are met or exceeded. (50%)
• Generating monthly, weekly, & daily reports to support contractor management in meeting or exceeding department goals. (40%)
• Reviewing Fraud reporting to identify potentially fraudulent customers or contractors for investigation. (10%)

Total: 100%

• Bachelor's degree in business, finance, or related field.
• At least 2 years of experience in data analysis, reporting, auditing, or related field and a good working knowledge of Contractor Operations processes.
• Advanced knowledge of Microsoft Excel and proficiency in other Microsoft applications (Word, PowerPoint).
• Experience with field service management applications such as Service Bench, Service Titan or Dispatch Technologies preferred.
• Strong analytical mind, critical thinking, and logical reasoning with the ability to make solution‑oriented decisions that will guide business action.
• Excellent and accurate data entry skills with strong attention to detail.
• Self‑driven and exceptional organizational, time management, and independent problem‑solving skills with the ability to work in a team environment and independently.
• Feel comfortable working in an autonomous environment where you are expected to be self‑managed, while responsible for meeting or exceeding personal and departmental goals.
• Strong time management and organization skills and the ability to shift priorities based on the needs of the business.
• Adept at managing multiple…