Insurance Fraud Investigator
Reports to: Classification: Date: Job Function: To investigate possible cases of insurance fraud, assemble evidence, and recommend action steps to unit head for discussion with company attorneys. Develop a broad presence in the company and availability to assist line managers with questions about cases of possible fraud. ESSENTIAL FUNCTIONS: 1. Receives investigation assignments from unit head or directly from field, regional, division, or headquarters offices. Provides telephone or written guidance to line managers or meets with them to discuss case and develop further investigation steps where warranted. 2. Works with field manager to investigate case and develop detailed evidence of possible fraud. Reviews paperwork collected and recommends securing additional background information that may be needed for the case. 3. Conducts field investigations and, with approval of unit head, initiates surveillance activities. May photograph or videotape activities. 4. Manages the case until closing. 5. Interfaces with civil authorities, investigators from other insurance companies, and contacts at insurance information bureau. 6. Updates unit head regularly on progress of investigations and recommendations for further initiatives or closing of the case. 7. Assists unit head in presenting training programs on fraud detection to field and headquarters personnel. ADDITIONAL RESPONSIBILITIES: 1. May represent the fraud investigation unit at industry conferences. 2. Participates in interviewing cycle for new candidates for fraud investigator job. 3. May substitute for an absent unit head. QUALIFICATIONS: 1. A bachelor's degree, preferably with a finance major. 2. Former state or municipal police experience, preferably in a detective assignment. 3. Ability to represent a positive public image for the company. Department: Division: Approved: