Insurance Claims Investigator

3 weeks ago


Phoenix, Arizona, United States USAA Full time
About the Role

As a dedicated Investigator - Insurance Claims, you will play a critical role in protecting USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance with state insurance fraud-related laws and regulations and policies and procedures.

Key Responsibilities
  • Apply knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third-party claims.
  • Participate in the development of fraud prevention strategies.
  • Apply knowledge of P&C insurance industry products, services, and processes in investigating claims to include P&C insurance policy contracts, coverages, and internal claims handling process and procedures.
  • Apply knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
  • Collect evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.
  • Develop and maintain external relationships with industry, law enforcement, and other contacts involved in fraud investigation, detection, and prevention.
  • May serve as a resource team member on specific matters through demonstrated skill or training.
  • Assist with the delivery of fraud awareness training initiatives in a defined environment.
  • Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
Requirements
  • 2 years claims adjusting experience, or P&C SIU/Fraud Investigation experience OR 4 years prior investigative law enforcement (to include military) or relevant fraud industry investigation experience.
  • Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.
  • Familiarity with using computers and various software packages to enter and extract data for analysis from relevant data sources and systems.
  • Knowledge of city, state, and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.
What We Offer

USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

At USAA, our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental, and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs.



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