The Special Investigator protects the assets of the organization by avoiding the payment of fraudulent claims in accordance with the applicable law and policy provisions. Gather facts of the loss without exposing the company to bad faith damages.
- Conducts timely investigations of suspected fraudulent claims to ensure a prompt and accurate claims decision.
- Conducts COMPLEX RECORDED INTERVIEWS to validate a claim or identify persons or organizations that are involved in suspicious related activities.
- Maintains assigned claims files in confidential manner and ensures that all relevant facts pertaining to the files are documented in the appropriate claims handling system.
- Ensures that assigned cases are investigated and reported back to the requesting party in adherence to Special Investigation Unit Best Practice.
- Concludes investigation and prepares investigative reports in adherence to Special Investigation Unit Best Practices.
- Initiates referrals to State Insurance Department, Fraud bureaus and NICB when a suspicious or fraudulent activity has been identified.
- Maintains investigative databases.
- Assist all Assurant subsidiaries and accounts with investigations. Works with state fraud bureaus, law enforcement agencies and other special investigative units in combating insurance fraud with direction from Special Investigator II and Senior Investigator.
- Performs other duties as assigned.
- Analyzes results of investigations to determine course of action documents activities of claims handling practices.
- Conducts interviews and obtains detailed recorded statements from all involved parties.
- Requests, prepares, documents, and may conduct examinations under oath and/or sworn statements including those involving attorney representation.
- Conducts thorough searches using investigative databases, internal resources, internet resources, and public records to locate parties and collect evidence to determine if potential fraud exists.
- Obtains, evaluates, and summarizes law enforcement reports, credit reports, medical documentation, and affidavits in relation to loss including documentation from required parties in accordance with state and federal regulations.
- Present investigative findings through written reports and recommends whether to take further actions.
- Testifies at depositions, hearings, and trials.
- Develops and maintains a rapport with local information networks to include law enforcement, vendors, and industry experts.
- Bachelor’s Degree in Criminal Justice, Business or Criminal Justice Degree in Basic Law Enforcement from accredited college is required.
- Minimum three years in law enforcement (investigative work experience) or a minimum of five years in a Special Investigation Unit/Private Investigation experience or Insurance Claims experience.
Preferred Experience, Skills, and Knowledge:
- Working knowledge of special investigative techniques. Effective communicator with analytical skills. Strong knowledge of researching databases is required.
- Detail-oriented with strong organizational skills, able to work well under deadlines in a changing environment and perform multiple tasks effectively and concurrently.
- Demonstrated ability to manage relationships with both internal and external customers.
- Demonstrated ability to work effectively independently and within a collaborative team-oriented environment using sound judgment in decision-making.
- Excellent communication skills both oral and written skills with strong analytical skills to investigate insurance fraud.
- Demonstrated proficiency with Microsoft Office products (Excel, PowerPoint, and Word) and claims related software programs.
- Ability to work in a fast-paced environment.
- Handle high volume of investigations and remain timely on status reports.