Claim Investigator (Non-Injury) - CSIU

AAA-The Auto Club Group; United States; Hybrid; USD 70,000 - 95,000; Full time

Job summary

AAA-The Auto Club Group is seeking a skilled Claim Investigator to review and investigate insurance claims for validity, accuracy, and regulatory compliance. You will gather evidence, interview claimants and witnesses, and examine documents such as police reports and property damage assessments to support fair and timely resolutions.

The role focuses on identifying potential fraud, verifying claim details, and collaborating with claims teams in a hybrid work environment.

Responsibilities

• Independently assess and investigate personal lines P&C claims for potential fraud.
• Maintain understanding of policies, claim handling, eligibility and underwriting.
• Understand claim fraud schemes and how insureds, providers, and rings operate.
• Comply with state laws and regulations governing fraud investigations.
• Collaborate with the assigned claims representative and keep them informed.
• Review claims to identify fraud scenarios, including premium fraud.
• Carry out investigations to prove or disprove fraud.
• Identify involved parties and conduct interviews or statements.
• Obtain documents relevant to the investigation with consent.
• Perform vehicle or home inspections and site visits.
• Obtain and follow up on police and official reports.
• Perform link analysis to map relationships.

Job description

Job Type

Full time

Exempt/Non Exempt

Salary

Job Description

Location Details

Hybrid

Position Schedule / Shift

Monday-Friday 8am-5pm ET

Position Summary

The Auto Club Group is seeking a highly skilled Claim Investigator who would be responsible for reviewing and investigating insurance claims to determine their validity, accuracy, and compliance with company policies and regulatory requirements. They gather and analyze evidence, interview claimants, witnesses and other involved parties, and examine documentation such as police reports and property damage assessments. Their goal is to identify potential fraud, verify claim details, and support fair and timely claim resolutions.

Key Responsibilities

• Independently perform comprehensive assessment and investigation of personal lines property & casualty claims for the potential of claim fraud.
• Maintain a thorough understanding of insurance policies and claim handling practices and procedures, as well as insurance policy eligibility and underwriting requirements.
• Maintain a comprehensive understanding of claim fraud, including the fraud scenarios and methods by which insureds, claimants, service providers, and other parties may engage in opportunistic fraud, and also the ways in which businesses, professionals and organized crime groups, such as fraud rings, operate.
• Understand and comply with state laws, regulations, and case law impacting claim fraud and investigation activities.
• Contact the claim representative assigned to the claim, work with them collaboratively, and keep them informed throughout the claim investigation.
• Review claims to identify the potential fraud scenarios that might be present, both for claim fraud and also policy premium fraud.
• Complete investigative activities that will help prove or disprove the presence of fraud.
• Investigative activities may include identifying insureds, claimants, witnesses, service providers, and other parties and completing interviews or recorded statements.
• Obtain customer records such as utility bills and other documents pertinent to the investigation and when necessary, with the permission of the insured.
• Complete vehicle inspections, home inspections, or conduct site-visits.
• Obtain and follow-up on public records, as well as police, fire and other official reports.
• Complete link analysis to understand the relationships between people