Fraud Investigations Lead - Claims & SIU

Central Insurance; Van Wert (OH); Hybrid; USD 70,000 - 110,000; Full time

Job summary

Central Insurance in Ohio is seeking an Anti-Fraud Special Investigator to join our Special Investigative Unit. You will partner with claims professionals, regulatory agencies, and law enforcement to investigate suspected insurance fraud and train others in anti-fraud techniques.

Hybrid work arrangement across Van Wert/Dublin locations; requires field and desk investigations, strong judgment, and ability to manage investigations end-to-end while maintaining compliance and timely reporting.

Qualifications

• Bachelor’s Degree in related field with 2 years’ experience in law enforcement/SIU or multi-line claims
• Or 4 years’ experience in law enforcement/SIU or multi-line claims
• Experience in investigation of insurance fraud
• Travel up to 10-20% for field work

Responsibilities

• Provides proactive customer service throughout the life of the file by appropriately setting expectations, building rapport, and responding to requests timely of both internal/external customers
• Identifies and conducts thorough investigations of suspicious claims, review documentation and develop investigative actions
• Conducts field as well as desk investigations of insurance claims referred to the Special Investigative Unit from direct adjuster referral or by various analytic platforms
• Coordinates investigations with outside SIU contacts, the Department of Insurance Fraud Division, NICB, and various law enforcement agencies
• Initiates referrals when a suspicious or fraudulent activity has been identified
• Initiates referrals to State Insurance Department, Fraud bureaus and NICB when a suspicious or fraudulent activity has been identified.
• Develops and presents anti-fraud training programs within claims organization
• Ensures budgets are established and documented in claim file and all invoices reviewed and documented
• Creates monthly reports in a well-written manner, reflecting activity in specific region
• Complies with State Requirements for reporting questionable claims and documented within Case Manager
• Handles work comp files
• Handles bodily injury files
• Conducts claims fraud training and/or technical training
• Conducts own examination under oath (EUO)
• Handles major case overflow files

Skills

Microsoft Office

Communication skills

Investigation skills

Integrity and ethics

Interpersonal skills

Detail oriented

Education

Bachelor’s Degree in related field

Law enforcement/SIU experience

Job description

Central Insurance in Ohio is seeking an Anti-Fraud Special Investigator to join our Special Investigative Unit. You will partner with claims professionals, regulatory agencies, and law enforcement to investigate suspected insurance fraud and train others in anti-fraud techniques.

Hybrid work arrangement across Van Wert/Dublin locations; requires field and desk investigations, strong judgment, and ability to manage investigations end-to-end while maintaining compliance and timely reporting.