Hybrid Insurance Fraud Investigator: Data-Driven Sleuth

NYCM Insurance; United States; Hybrid; USD 55,000 - 90,000; Full time

Job summary

NYCM Insurance seeks a Fraud Investigator to conduct investigations of suspected insurance fraud and prepare professional reports with recommendations. The role involves reviewing evidence, interviewing sources, and coordinating with SIU and Claims teams to synthesize data.

Responsibilities include identifying leads from data and databases, providing timely written reports per NYS regulations, testifying in court, and maintaining detailed case logs while staying current on investigative

Qualifications

• Associate or bachelor's degree in criminal justice or related field, OR five years of insurance claims investigation experience, OR professional investigation experience with law enforcement agencies, OR seven years of professional investigation experience involving economic or insurance related matters.
• Knowledge of New York State regulations and company policies.
• Familiar with civil and criminal law and all other laws that may impact an investigation or results.
• Proficient with SIU resources (cameras, computers, recorders).
• Good computer skills including email and databases.
• Proficient Word and Excel skills.
• Organized; detail oriented; investigative thought process.
• Excellent verbal and written communication and active listening.
• Ability to work independently and take direction.
• Ability to analyze data to identify leads and potential investigations.
• Ability to work in less-than-ideal situations and locations during investigations.

Responsibilities

• Conduct investigations in accordance with company, SIU, statutory, regulatory, and other legal guidelines.
• Identify leads and potential investigations from data, databases, and/or spreadsheets.
• Give regular, timely, and accurate written reports to the referring party in accordance with New York State regulation and company policies.
• Conduct interviews and take recorded or written statements.
• Verify receipts, complete activity checks, and other investigative processes with SIU resource materials such as cameras, computers, and recorders.
• Maintain chronological case order.
• Report all suspected instances of insurance fraud in accordance with regulations.
• Testify in court.
• Brief management.
• Maintains an accurate factual log of activities on all files.
• Regularly interface with law enforcement or regulatory agencies.
• Regular liaison between SIU Field Investigators, EFW Examiners, and Claims Examiners.
• Maintain technical proficiency with SIU resource materials i.e., cameras, computers, recorders, etc.
• Remain current in insurance investigative techniques and knowledge through course and training module as assigned.
• Remain familiar with civil law, criminal law, and all other laws that may impact an investigation or how to deal with the results.
• Other duties as assigned.

Skills

Data analysis

Communication skills

Microsoft Word

Microsoft Excel

Independent work

Interviewing

Attention to detail

Education

Associate or Bachelor's degree in criminal justice or related field

Tools

Cameras

Computers

Recorders

Job description

NYCM Insurance seeks a Fraud Investigator to conduct investigations of suspected insurance fraud and prepare professional reports with recommendations. The role involves reviewing evidence, interviewing sources, and coordinating with SIU and Claims teams to synthesize data.

Responsibilities include identifying leads from data and databases, providing timely written reports per NYS regulations, testifying in court, and maintaining detailed case logs while staying current on investigative