Senior Special Claims Investigator

Bachelor’s Degree in Criminal Justice, Risk Management and Insurance, Business Administration, or a related field or equivalent experience.
Generally, a minimum of 6 years of casualty claim handling experience with some Criminal Investigation or Fraud Detection experience.
Strong knowledge of Claims investigation laws and regulations.
Ability to identify and address subtle details that could impact the outcome of an investigation.
Demonstrated advanced ability to organize and prioritize caseloads, ensuring timely completion of investigations.
Excellent interpersonal and communication skills to collaborate with appropriate parties to ensure thorough and accurate claims settlements.
Proven ability to handle confidential information with discretion.
Excellent analytical skills with the ability to use data to analyze situations, identify problems, and develop effective solutions.

Detects and prevents fraudulent claims through meticulous investigation and complex analysis.
Analyzes and interprets data to identify inconsistencies, potential fraud, and the overall legitimacy of claims.
Prepares comprehensive reports summarizing investigation findings and recommends claim approval or denial.
Evaluates claims and may recommend courses of action to management.
Ensures claims are settled accurately and fairly, minimizing fraudulent activities and protecting the company’s financial interests.
May present evidence and/or deliver testimony in situations where law enforcement agencies seek prosecution.
Contributes to the continuous improvement of investigation processes and techniques, enhancing overall efficiency and effectiveness.
May contribute to the development of program awareness initiatives or facilitate training sessions focused on the detection, deterrence, and prevention of fraudulent activities.
Performs other duties as assigned.

Continuing progress toward and/or the completion of a professional designation preferred, such as Certified Insurance Fraud Investigator (CIFI), Certified Fraud Examiner, or Private Investigator license from a National Investigation Organization or State Agency.