Insurance Claims Investigator

7 days ago

Melville, New York, United States Allied Universal Compliance and Investigations Full time
Job Summary

We are seeking a highly skilled and experienced Insurance Claims Investigator to join our Special Investigations Unit (SIU) at Allied Universal Compliance and Investigations. As a key member of our team, you will be responsible for investigating suspected fraudulent insurance claims and working closely with clients and case managers to gather information and evidence.

Key Responsibilities
  • Investigate Suspected Fraudulent Claims: Independently investigate claims with red flags that suggest fraudulent behavior in relation to an insurance claim.
  • Conduct Research and Gather Information: Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance.
  • Document Investigations: Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed.
  • Produce Reports and Memos: Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct.
  • Verify Database Indices: Run appropriate database indices if necessary and verify the accuracy of results found.
  • Develop Strategic Plans: Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor.
Requirements
  • Education and Experience: Must possess one or more of the following: Bachelor's degree in Criminal Justice, High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud.
  • Licensing and Certification: Ability to be properly licensed as a Private Investigator as required by the state where work is completed.
  • Training and Orientation: Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course.
  • Insurance Investigations Experience: Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims.
  • Knowledge of Anti-Fraud Laws and Regulations: Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.
  • Technical Skills: Proficient in utilizing laptop computers and cell phones.
  • SIU Compliance Knowledge: Special Investigative Unit (SIU) Compliance knowledge.
  • Typing Speed and Accuracy: Ability to type 40+ words per minute with minimum error.
  • Flexibility and Availability: Flexibility to work varied and irregular hours and days including weekends and holidays.
Preferred Qualifications
  • Military Experience: Military experience.
  • Law Enforcement Experience: Law enforcement experience.
  • Insurance Administration Experience: Insurance administration experience.
  • California SIU Regulations: Familiarity with California SIU regulations.
  • Professional Industry Certifications: One or more of the following professional industry certifications: Certified Fraud Investigator (CFE), Certified Insurance Fraud Investigator (CIFI), Fraud Claim Law Associate (FCLA), Fraud Claim Law Specialist (FCLS), Certified Protection Professional (CPP), Associate in Claims (AIC), Chartered Property Casualty Underwriter (CPCU).
Benefits
  • Pay Rate: $32 - $38 / hr.
  • Medical, Dental, Vision, and Life Insurance: Medical, dental, vision, basic life, AD&D, and disability insurance.
  • 401(k) Plan: Enrollment in our company's 401(k) plan, subject to eligibility requirements.
  • Paid Holidays and Sick Days: Seven paid holidays annually, sick days available where required by law.
  • Vacation Time: Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full-time positions. Unused vacation is only paid out where required by law.

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