Fraud Investigator

7 days ago

Sherburne NY, United States NYCM Insurance Full time

The Fraud Investigator is responsible for conducting investigations and reporting suspected instances of insurance fraud. The Fraud Investigator reviews and researches evidence and documents to analyze the overall fact pattern of claim and synthesis data into professional reports with recommendations.

Duties & Responsibilities:

  • Conduct investigations in accordance with company, SIU, statutory, regulatory, and other legal guidelines.
  • Identify leads and potential investigations from data, databases, and/or spreadsheets.
  • Give regular, timely, and accurate written reports to the referring party in accordance with New York State regulation and company policies.
  • Conduct interviews and take recorded or written statements.
  • Verify receipts, complete activity checks, and other investigative processes with SIU resource materials such as cameras, computers, and recorders.
  • Maintain chronological case order.
  • Report all suspected instances of insurance fraud in accordance with regulations.
  • Testify in court.
  • Brief management.
  • Maintains an accurate factual log of activities on all files.
  • Regularly interface with law enforcement or regulatory agencies.
  • Regular liaison between SIU Field Investigators, EFW Examiners, and Claims Examiners.
  • Maintain technical proficiency with SIU resource materials i.e., cameras, computers, recorders, etc.
  • Remain current in insurance investigative techniques and knowledge through course and training module as assigned.
  • Remain familiar with civil law, criminal law, and all other laws that may impact an investigation or how to deal with the results.
  • Other duties as assigned.

Requirements:

  • Associates Degree or Bachelor's Degree in Criminal Justice or related field OR 5 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies OR 7 years of professional investigation experience involving economic or insurance-related matters.

Skills & Qualifications:

  • Working knowledge of New York State regulations and company policies.
  • Familiar with civil and criminal law and all other laws that may impact an investigation or results.
  • Technical proficiency with cameras, computers, recorders, and all SIU resource materials.
  • Good computer skills including electronic email and databases.
  • Proficient Microsoft Word and Excel skills.
  • Organized; detail oriented; investigative thought process.
  • Excellent communication skills including verbal and written and active listening.
  • Ability to work independently and take direction.
  • Ability to analyze data to identify leads and potential investigations.
  • Ability to at times work in less-than-ideal situations and locations while performing investigation

Market range: 6 / 40 hours per week / Hybrid

Salary Range: $47,400 - $73,700

Accepting applications until: 11/17/2025

Behaviors

Preferred

  • Team Player: Works well as a member of a group
  • Loyal: Shows firm and constant support to a cause
  • Leader: Inspires teammates to follow them
  • Thought Provoking: Capable of making others think deeply on a subject
  • Functional Expert: Considered a thought leader on a subject
  • Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
  • Dedicated: Devoted to a task or purpose with loyalty or integrity

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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