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Insurance Claims Investigator

1 month ago

Burlington, Vermont, United States Allied Universal® Compliance and Investigations Full time
Job Summary

Allied Universal Compliance and Investigations is seeking a highly skilled Insurance Claims Investigator to join our team. As a Special Investigations Unit (SIU) Investigator, you will be responsible for investigating claims with red flags that suggest fraudulent behavior. You will use your extensive knowledge of insurance policies and the components of fraud to determine if claims warrant reporting to the appropriate state agency for prosecution.

Key Responsibilities
  • Independently investigate suspected fraudulent insurance claims for various coverage types, including workers' compensation, general liability, property, and casualty.
  • Acquire and gather information through data collection, interviews, research, and collaboration with other SIU entities, law enforcement, and state Departments of Insurance.
  • Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed.
  • Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct.
  • Run appropriate database indices if necessary and verify the accuracy of results found.
  • Develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor.
Requirements
  • Bachelor's degree in Criminal Justice or a related field.
  • 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.
  • Ability to be properly licensed as a Private Investigator as required by the state where work is completed.
  • Post-offer, must be able to successfully complete the Allied Universal Investigations training/orientation course.
  • Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims.
  • Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.
  • Proficient in utilizing laptop computers and cell phones.
  • Special Investigative Unit (SIU) Compliance knowledge.
  • Ability to type 40+ words per minute with minimum error.
  • Flexibility to work varied and irregular hours and days, including weekends and holidays.
Preferred Qualifications
  • Military experience.
  • Law enforcement experience.
  • Insurance administration experience.
  • Familiarity with California SIU regulations.
  • 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
  • Auto allowances provided to investigators.
  • Company credit card for all fuel and travel.
  • Job flexibility offering both field and remote work.
  • Investigations-related educational opportunities and paid training.
  • Excellent technology designed to improve your work-life balance.
  • Opportunity for maximum OT earnings.

Allied Universal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status, or relationship/association with a protected veteran, or any other basis or characteristic protected by law.