Job Summary:

The Insurance Fraud Investigator will investigate possible cases of insurance fraud, assemble evidence to build a case, and then recommend further action to the appropriate enforcement and compliance officers.

Supervisory Responsibilities:

• May participate in hiring and interview process for potential fraud investigators.

Duties/Responsibilities:

• Interviews key witnesses to gather initial information regarding suspicions of fraudulent claims, inconsistent behavior, and other supporting evidence.
• Identifies appropriate investigative steps, which may include conducting field investigations, surveillance, and interviews.
• Gathers evidence and information; determines whether initial evidence is sufficient to establish a claim and build a case.
• Prepares regular case status and progress reports for supervisor; recommends pursuit of further investigation or conclusion of case.
• Manages the case until resolved.
• Maintains required records and documentation.
• Collaborates with civil authorities, contacts at insurance information bureaus, and other investigators as needed to build and support developing cases.
• Develops and presents, or assists with, fraud detection training and educational programs.
• Performs other related duties as requested.

Required Skills/Abilities:

• Basic understanding of human behavior and performance.
• Basic understanding of relevant equipment, policies, procedures, and strategies to conduct investigations and to promote security operations.
• Ability to identify discrepancies and problems.
• Excellent verbal and written communication skills.
• Thorough understanding of laws related to insurance fraud.
• Proficient in Microsoft Office Suite or related software.

Education and Experience:

• Bachelors degree required; coursework in related areas such as criminal justice or psychology preferred.
• Former police or investigative experience required; detective experience highly preferred.

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.
• Must be able to travel and access various areas in the course of investigations.