Senior Special Investigator

Conducts special investigations of claims including major or more complex losses as directed to confirm claim validity or to identify fraud. Assists Field Claims employees and the Agency Force in recognizing and resisting fraudulent claims. Prepares and conducts fraud awareness/resistance training; may assist Investigations Team Leaders and Management personnel with technical support. Establishes and maintains liaison and cooperation with public and private organizations charged with prevention, detection and prosecution of insurance fraud; coordinates and directs the efforts of contracted private investigators.

Position Requirements

Conducts investigations into claims, as directed, using sound investigative techniques in compliance with all federal, state and local laws pertaining to investigations and fair claims handling practices. Investigation may involve vehicle or public carrier travel, field interview, use of photographic and sound recording devices and other trade instruments. Reports findings of investigations to the Special Investigations Manager or Field Claims Manager as directed. Prepares accurate, timely reports of all investigative activities, maintaining careful control of evidence retrieved in the course of investigations. Coordinates and directs the activities of private investigators, when use is authorized, ensuring timely, cost effective results and reports. Reviews private investigator billings to assure that all work billed was satisfactorily performed. Assists in recruiting and orientation of private investigators. Assists in training and counseling employees and agents in fraud recognition, investigation and resistance. Reviews and evaluates claims procedures for effectiveness in the avoidance, identification and resistance of fraudulent claims, and reports deficiencies to the Special Investigations Manager. Acts as company liaison with law enforcement and other entities, as directed, on matters related to claims fraud and fraud reporting requirements. Coordinates the efforts of internal and outside resources in the investigation of complex and unusual claims situations, such as fraud rings. Assists the Special Investigations Manager with administrative duties inclusive of, but not limited to case assignments, training of agents and employees, meeting attendance, relief supervision of investigators, operational analyses, reporting, budget, etc. Performs other duties as assigned.

Preferred Skills and Abilities

Enter preferred skills and abilities.

Physical Actions

Bending Pulling Sorting Carrying up to 20 lbs. Pushing Speaking (English) Climbing Reaching Standing Key entering Reading (English) Walking Kneeling Seeing Writing (English)

Physical Environment

Required job duties are normally performed in a climate-controlled office environment, but with exposure to some or all of the following environments when in the field: Uncontrolled outside environmental conditions Excessive Noise Levels Chemicals Chemical/Biological Conditions Moving Mechanical Parts Areas considered dangerous Conditions, which could affect the respiratory system or skin such as: fumes, odors, dust, mists, gases, oils, smoke, soot, or poor ventilation.

Education Requirements

Four-year college degree. Completion of, or actively pursuing a major insurance designation, or actively pursuing insurance related courses.

Experience Requirements

External candidates should have a minimum of two years of prior claims experience or equivalent outside law enforcement or claims investigation experience. The same time-on-job requirement is preferred for internal candidates.

Special Skills Requirements

Communication Personal Computer Literate Valid driver's license Bondable Note: May be called upon to perform job duties outside of standard business hours.

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