Senior Investigator – Special Investigations Unit, Illinois, Indiana, Michigan

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

📋 Description

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

• Collaborate independently and in partnership with internal stakeholders and external entities to assess suspicious insurance activity.

• Gather evidence and bolster fraud detection initiatives.

• Present investigative outcomes to internal and external stakeholders, regulatory bodies, and law enforcement agencies.

• Recognize warning signs, collect facts, and document evidence in adherence to company policies and legal standards.

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

• Employ checklists, referral standards, and scoring tools to assess the necessity of further investigation.

• Conduct and oversee comprehensive investigations of suspect, high-exposure, and complex claims along with underwriting/policy issues.

• Lead advanced inquiries into organized fraud schemes and develop significant cases for potential criminal prosecution.

• Assess, coordinate, and propose investigative strategies in collaboration with claims, underwriting, and legal teams.

• Oversee and manage external vendor activities associated with assigned Special Investigations Unit (SIU) investigations.

• Create detailed investigative reports and facilitate referrals to law enforcement, legal proceedings, and state fraud bureaus.

• Stay up-to-date on regulations, statutes, internal protocols, and operational procedures.

• Maintain 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 complex investigations.

• Mentor and provide peer training to the SIU team on investigative strategies and methodologies.

⛳️ Requirements

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

• Advanced skills in insurance fraud investigation, including evidence collection and interviewing techniques.

• Proficient in following investigative protocols and best practices.

• Strong written and verbal communication abilities, with the capability to condense complex findings.

• Team-oriented mindset and dedication to ongoing learning as tools, regulations, and fraud strategies evolve.

• Proficient in using investigative databases and standard office software.

• Competent in computer and software applications for data entry, digital research, and investigative analysis.

• Ability to perform digital photo and video documentation of loss scenes and evidence.

• Capability to effectively utilize AI-driven investigative tools, such as fraud scoring.

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

🏝️ 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 the month of hire

• Enhanced PTO may be available for experienced candidates

• Bonus eligibility based on performance