Senior Investigator – Special Investigations Unit

This is a fully remote position, open to applicants in Illinois, +1 more state.

📋 Description

• Conduct investigations into potential insurance fraud related to auto, property, casualty, workers’ compensation, as well as various personal, commercial, and specialty lines.

• Collaborate with internal stakeholders and external partners, while also working independently to assess suspicious insurance transactions.

• Gather evidence and bolster fraud detection initiatives.

• Relay investigative results to internal and external partners, regulatory bodies, and law enforcement agencies.

• Recognize red flags, compile facts, and document evidence in alignment with company policies and legal standards.

• Analyze claim files for discrepancies, delayed reporting, coverage issues, questionable damages, and medical billing concerns.

• Execute and oversee comprehensive investigations of suspicious, high-risk, and intricate claims along with underwriting and policy matters.

• Undertake in-depth investigations into organized fraud schemes and formulate significant cases for potential criminal prosecution.

• Coordinate investigative strategies with claims, underwriting, and legal teams.

• Oversee and manage external vendor activities linked to assigned Special Investigations Unit (SIU) inquiries.

• Draft comprehensive investigative reports and facilitate referrals to law enforcement, legal proceedings, or state fraud bureaus.

• Remain updated on regulations, statutes, internal protocols, and procedures.

• Ensure meticulous documentation in line with SIU operating standards and best practices.

• Act as a subject matter expert for claims and underwriting training focused on fraud detection, deterrence, prevention, and sophisticated investigations.

• Provide mentorship and peer training to SIU team members on investigative strategies and methodologies.

• Allocate at least 50% of work hours in the field servicing the designated territory.

⛳️ Requirements

• 8-10 years of experience in fraud investigation, claims investigation, SIU support, or comparable research/analyst roles, or an equivalent mix of education and experience.

• Proficient in advanced insurance fraud investigative techniques, including evidence collection and interviewing skills.

• Proven ability to adhere to investigative processes and best practices.

• Strong written and verbal communication skills, capable of summarizing complex findings effectively.

• A collaborative attitude and a commitment to ongoing learning as tools, regulations, and fraud schemes evolve.

• Competent in utilizing investigative databases and standard office software.

• Ability to operate computers and software for data entry, digital research tools, and investigative analysis.

• Skilled in conducting digital photo and video documentation of loss scenes and evidence.

• Capable of effectively working with AI-enhanced investigative tools, such as fraud scoring systems.

• Must cover the Illinois, Indiana, and Michigan regions.

• Availability for full-time work.

🏝️ Benefits

• Medical & Prescription Insurance

• Health Savings Account

• Dental Insurance

• Vision Insurance

• Short and Long Term Disability

• Flexible Spending Accounts

• Life and Accidental Death & Disability Insurance

• Accident and Critical Illness Insurance

• Employee Assistance Program

• 401(k) Plan with Company Match

• Pet Insurance

• Paid Time Off; standard first-year PTO is 17 days, prorated based on month of hire

• Enhanced PTO may be available for experienced candidates

• Bonus eligibility based on performance