Insurance Fraud Investigator

4 days ago


Milwaukee, Wisconsin, United States Tier4 Group Full time

Job Title: Special Investigations Unit Specialist

Location: Remote

Type: Hybrid (3 days onsite per week)

Duration: ASAP - ASAP

Perks: Competitive Rates, Benefits, free daily lunch when onsite

Job Summary:

We are seeking a diligent and detail-oriented investigator to review, assess, and analyze suspicious activities, including potentially fraudulent, sanctioned, or illegal acts governed by state insurance fraud regulations. The role involves conducting thorough due diligence for New Business applications, corporate investments, and public-facing ventures, and facilitating regulatory reporting to the appropriate authorities.

Primary Duties & Responsibilities:

  • Conduct comprehensive research and due diligence reviews on New Business applications, Managed Investments, corporate investments, and public records.
  • Evaluate Life, Disability Income (DI), and Long-Term Care (LTC) Underwriting applications for indications of fraud.
  • Prepare reports for federal and state regulatory agencies, ensuring compliance with statutory and regulatory requirements.
  • Collaborate with senior investigators to compile and review larger investigative reports and respond to additional requests for information.
  • Assist in preparing and assembling investigative materials in coordination with federal, state, and other governmental or private agencies as required by law.

Qualifications:

  • Bachelor's degree or equivalent experience in a related field such as Insurance Services or Fraud Investigation.
  • Proven ability to manage a dynamic workload independently while maintaining superior organizational and time management skills.
  • Strong attention to detail with the ability to consistently apply policies and procedures.
  • Experience working within a small, collaborative team, providing cross-functional support as needed.

About the Team:

As a member of our dedicated team of investigators, you will provide critical investigative and research services across the enterprise.



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