Insurance Claims Investigator

6 days ago

Baltimore, Maryland, 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) team 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 build cases.

Key Responsibilities
  • Investigate Claims: Independently investigate suspected fraudulent insurance claims for various coverage types, including workers' compensation, general liability, property, and casualty.
  • Gather Information: Acquire and gather information through 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: Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct.
  • Verify Results: 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 SIU Supervisor.
Requirements
  • Education and Experience: Must possess one or more of the following: Bachelor's degree in Criminal Justice or 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 and Skills: 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: Ability to type 40+ words per minute with minimum error.
  • Flexibility: Flexibility to work varied and irregular hours and days, including weekends and holidays.
Preferred Qualifications
  • Military Experience: Military experience.
  • Law Enforcement: Law enforcement experience.
  • Insurance Administration: Insurance administration experience.
  • California SIU Regulations: Familiarity with California SIU regulations.
  • Professional 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
  • Medical, Dental, and Vision 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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