Senior Investigator – Special Investigations Unit

This is a fully remote position, open to applicants in Kentucky, +3 more states.

📋 Description

• Investigate potential insurance fraud related to auto, property, casualty, workers’ compensation, and various personal, commercial, and specialty lines.

• Collaborate with both internal stakeholders and external partners to assess suspicious insurance transactions.

• Gather evidence and support initiatives for fraud detection.

• Effectively communicate investigative findings to internal and external partners, regulators, and law enforcement agencies.

• Identify warning signs, collect relevant facts, and document evidence in accordance with company policies and legal standards.

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

• Utilize checklists, referral criteria, and scoring tools to ascertain if further investigation is necessary.

• Conduct investigations of moderate to high complexity with minimal supervision using field, desktop, or hybrid methods.

• Assess, coordinate, and propose investigative action plans in collaboration with claims, underwriting, and legal partners.

• Manage and oversee outside vendor activities for designated Special Investigations Unit (SIU) investigations.

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

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

• Maintain records of investigative actions and outputs in line with SIU standards and best practices.

• Act as a subject matter expert in claims and underwriting training on fraud detection, deterrence, and prevention.

⛳️ Requirements

• 6-8 years of experience in fraud investigation, claims investigation, SIU support, or related research/analysis, or an equivalent combination of education and experience.

• Well-honed skills in evidence gathering and interviewing.

• Capability to adhere to investigative processes and best practices.

• Strong written and verbal communication abilities, including the capacity to summarize complex findings clearly.

• A collaborative mindset and dedication to continuous learning.

• Proficiency in investigative databases and standard office software.

• Competence in utilizing computers and software for data entry, digital research tools, and investigative analytics.

• Ability to document loss scenes and evidence through digital photography and videography.

• Proficient in working with AI-enabled investigative tools, such as fraud scoring, anomaly detection, entity/link analysis, and automated summarization, while applying sound judgment and documenting decision rationale.

• Strong analytical and problem-solving capabilities.

• Excellent interpersonal skills.

• Knowledge of fire cause and origin.

• A valid driver's license is required.

• Willingness to travel within the designated territories of Tennessee, North Carolina, Kentucky, and Virginia.

🏝️ 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, pro-rated based on the month of hire.

• Enhanced PTO may be available for experienced candidates.

• Bonus eligibility based on performance.

• Remote/work-from-home arrangement.

• Opportunities for meaningful work and professional development.