Claims Special Senior Investigator - Field

Westfield Insurance; Westfield Center (OH); Remote; USD 65,000 - 90,000; Full time

Job summary

Westfield Insurance seeks a Claims Special Senior Investigator to handle complex investigations in commercial and personal lines. This role involves conducting in-depth investigations, developing relationships with vendors, and providing expert insights into fraud-related claims while maintaining communication across various stakeholders.

Qualifications

• 5-7 years of experience in Claims Handling and/or Investigative Experience.
• Valid driver’s license and conforming driving record for field roles.

Responsibilities

• Conducts independent investigations of questionable claims.
• Develops and maintains relationships with vendors and stakeholders.
• Provides detailed investigative reports and potentially testifies in court.

Skills

Investigative Procedures

Fraud Investigation

Claims Handling

Fraud Detection

Data Analysis and Reporting

Education

Bachelor’s degree in Business Administration or related field

Job description

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Job Summary

The Claims Special Senior Investigator is responsible for handling commercial and personal lines investigations of moderate to high technical complexity with limited supervision. Conducts moderate volume investigations typically requiring outside investigation, including but not limited to in-person recorded statements, neighborhood canvases, and scene inspections. Acts as a resource/subject matter expert (SME) to other SIU investigators and field claims personnel. Develops and maintains positive and effective business relationships with SIU-related vendors, including officials, surveillance vendors, governmental agencies, etc.

Job Summary

The Claims Special Senior Investigator is responsible for handling commercial and personal lines investigations of moderate to high technical complexity with limited supervision. Conducts moderate volume investigations typically requiring outside investigation, including but not limited to in-person recorded statements, neighborhood canvases, and scene inspections. Acts as a resource/subject matter expert (SME) to other SIU investigators and field claims personnel. Develops and maintains positive and effective business relationships with SIU-related vendors, including officials, surveillance vendors, governmental agencies, etc.

Job Responsibilities

• Conducts or supervises quality independent, in-depth investigations of questionable or suspicious claims and completes and communicates timely, detailed, and accurate investigative reports on assignments.
• Initiates appropriate civil and/or criminal proceedings on all applicable claims that have the potential of being deemed as fraudulent in nature.
• Develops and maintains positive and effective business relationships with vendors, including officials, surveillance vendors, governmental agencies, etc.
• Determines appropriateness and feasibility of external investigations, and coordinates assignments to external vendors for investigations, such as social media, medical provider canvases, and surveillance.
• Maintains effective and ongoing communication with claims staff, internal and external business partners, insureds, claimants, agents, attorneys, other insurance companies, project team members, claims leadership, and vendors. Shares knowledge gained with others and is responsible for driving new and updated policies, processes and procedures.
• Remains current on industry topics, trends, processes, technology, best practices through research, industry events, networking, etc.
• Investigates claims of questionable nature with potential arson or fraud related concerns, covering all lines of business involving insureds, claimants, agents, brokers, attorneys, medical providers, etc.
• Performs in-depth investigation to develop sufficient evidence to assist the claims professional and recommend a final course of claim action.
• Develops and documents information on any investigation, file review, audit, training assignment, or other project as directed by writing detailed reports of their findings.
• Reports appropriate claims and investigative reports to state and local authorities and NICB, including those claims that meet NICB questionable database guidelines. Submits appropriate monthly reports to leader.
• Collects, safeguards and analyzes evidentiary information from various sources.
• Presents information and data to cross-functional stakeholders to educate and raise fraud awareness and prepares and presents detailed reports to leadership.
• May partner with Learning and Development to design and conduct professional courses and fraud awareness training for clients and employees.
• Testifies and provides evidence at administrative and criminal court proceedings as required, collaborates with other special investigative units and fraud related organizations to support their proceedings as required and offers expert advice to personnel regarding investigations.
• Leader Assistance - May direct staff and/or substitute for a leader.
• Travels as often as needed including regular utilization of assigned fleet vehicle in order to cover assigned territory. This may involve traveling on short notice or other daily driving duties as assigned, regardless of location.
  
  

Job Qualifications

• 5-7 years of experience in Claims Handling and/or Investigative Experience.
• Bachelor’s degree in Business Administration, Insurance or related field and/or commensurate work experience.
• For field roles only: Valid driver’s license and a driving record that conforms to company standards.
  
  

Location:

Remote

Licenses And Certifications

• Certified Insurance Fraud Investigator (CIFI) (preferred)
  
  

Behavioral Competencies

• Collaborates
• Communicates Effectively
• Customer Focus
• Decision Quality
• Nimble Learning
  
  

Technical Skills

• Investigative Procedures
• Fraud Investigation
• Claims Handling
• Fraud Detection
• Claims Investigation
• Insurance Industry Knowledge
• Technical Documentation
• Data Analysis and Reporting
• Claims Management System
  
  

This job description describes the general nature and level of work performed in this role. It is not intended to be an exhaustive list of all duties, skills, responsibilities, knowledge, etc. These may be subject to change and additional functions may be assigned as needed by management.

About Us

Founded in 1848, Westfield is a global leader in property and casualty insurance, delivering superior risk insights and innovative solutions to customers through a diverse portfolio of insurance products. Westfield underwrites commercial, personal, surety, and specialty lines of coverage through a network of leading independent agents and brokers in the United States and specialty products through Lloyd’s of London Syndicate 1200. As a mutual insurance company with more than 3,000 employees, Westfield has revenues in excess of $4 billion and more than $10 billion in assets.

Equal Opportunity Employer

United States: All applicants receive consideration for employment without regard to race, color, sex, religion, national origin, age, sexual orientation, gender identity, disability, or status as a protected veteran.

United Kingdom: Westfield is committed to equality of opportunity for all staff and applications from individuals are encouraged regardless of age, disability, sex, gender reassignment, sexual orientation, pregnancy and maternity, race, religion or belief and marriage and civil partnerships.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  Insurance

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