Senior Investigator – Special Investigations Unit
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Job Description
Senior Investigator investigating complex insurance fraud claims and organized schemes for West Bend. Servicing Illinois, Indiana, and Michigan through field and remote investigations.
Responsibilities:
- Investigate suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines of business
- Work independently and collaboratively with internal stakeholders and external partners to evaluate suspicious insurance transactions
- Collect evidence and support fraud detection programs
- Communicate investigative findings to internal and external partners, regulators, and law enforcement
- Identify red flags, gather facts, and document evidence in compliance with company policy and legal requirements
- Review claim files for inconsistencies, late reporting, coverage anomalies, questionable damages, and medical billing issues
- Conduct and lead thorough investigations of suspect, high-exposure, and complex claims and underwriting/policy concerns
- Conduct advanced investigations into organized fraud schemes and develop major cases and potential criminal fraud prosecutions
- Coordinate investigative action plans with claims, underwriting, and legal partners
- Coordinate and manage outside vendor activity related to assigned SIU investigations
- Prepare detailed investigative reports and support referrals to law enforcement, legal action, or state fraud bureaus
- Stay informed on regulations, statutes, internal protocols, and procedures
- Maintain thorough documentation in accordance with SIU operating standards and best practices
- Serve as a subject matter expert for claims and underwriting training on fraud detection, deterrence, prevention, and complex investigations
- Mentor and peer-train SIU team members on investigative strategy and methodology
- Spend at least 50% of working time in the field servicing the assigned territory
Requirements:
- 8-10 years of fraud investigation, claims investigation, SIU support, or related research/analyst experience or equivalent combination of education and experience
- Advanced insurance fraud investigative skills, including evidence gathering and interviewing
- Demonstrated ability to follow investigative processes and best practices
- Clear written and verbal communication skills, including ability to summarize complex findings
- Collaborative mindset and commitment to continuous learning as tools, regulations, and fraud tactics evolve
- Proficient in investigative databases and standard office software
- Ability to use computers and software for data entry, digital research tools, and investigative analysis
- Ability to conduct digital photo/video documentation of loss scenes and evidence
- Ability to work effectively with AI-enabled investigative tools, such as fraud scoring
- Must service the Illinois, Indiana, and Michigan territory
- Full-time availability
Benefits:
- Medical & Prescription Insurance
- Health Savings Account
- Dental Insurance
- Vision Insurance
- Short and Long Term Disability
- Flexible Spending Accounts
- Life and Accidental Death & Disability
- Accident and Critical Illness Insurance
- Employee Assistance Program
- 401(k) Plan with Company Match
- Pet Insurance
- Paid Time Off; standard first year PTO is 17 days, prorated based on month of hire
- Enhanced PTO may be available for experienced candidates
- Bonus eligible based on performance
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