Senior Complex Major Case Investigator: Insurance Fraud

Jobgether; United States; On-site; USD 105,000 - 110,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Life insurance

FSA

Dependent Care FSA

401(k) savings plan

Paid time off

Career advancement

Job summary

Jobgether, on behalf of our partner, seeks an SIU, Complex Major Case Investigator based in the United States. You will lead complex investigations into sophisticated insurance fraud schemes, synthesizing evidence from financial records, forensics, and sources to support claims decisions and regulatory actions.

Collaboration with Claims, Underwriting, and law enforcement, plus strong data-analysis and communication skills, are essential to disrupt fraud networks and uphold regulatory compliance

Qualifications

• Bachelor's degree in Criminal Justice, Data Analytics, Intelligence Studies, or a related field.
• 5–7 years of professional experience in complex insurance fraud investigations, particularly in Commercial Insurance, Property and Casualty (P&C), or Workers' Compensation, or in law enforcement or intelligence analysis.
• Demonstrated expertise in all-source intelligence gathering and analytical techniques applied to complex investigations.
• Strong analytical and quantitative skills, including the ability to interpret large datasets, identify patterns, and make evidence-based decisions.
• Proficiency with investigative databases, social media analysis, and data visualization tools is highly preferred.
• Excellent written and verbal communication skills, with the ability to present complex findings clearly to different audiences.
• Ability to work autonomously, demonstrate initiative, and exercise sound judgment and discretion.
• Strong understanding of insurance principles, fraud statutes, and privacy regulations.

Responsibilities

• Conduct complex investigations into suspected fraudulent claims and schemes involving claimants, healthcare or service providers, policyholders, and internal parties.
• Collect, preserve, and analyze evidence from multiple sources, including financial records, digital forensics, surveillance, social media, and public or private databases.
• Prepare detailed, accurate, and concise investigative reports to support internal claims decisions, law enforcement referrals, and courtroom proceedings.
• Manage an active caseload independently while collaborating with colleagues to meet deadlines and investigation objectives.
• Monitor fraud activity across products and channels, using statistical analysis to identify emerging patterns, trends, and systemic vulnerabilities.
• Apply all-source intelligence research, collection, and analysis techniques to identify fraudulent networks, key individuals, and their methods.
• Evaluate new data sources and investigative vendor tools to uncover emerging fraud patterns and improve predictive models and detection strategies.
• Deliver timely intelligence briefings to leadership on fraud trends, investigative tools, and the evolving threat landscape.
• Work closely with Claims, Underwriting, and Audit teams to provide investigative expertise and coordinate fraud response strategies.
• Serve as a liaison with external partners, including law enforcement, regulatory agencies, the National Insurance Crime Bureau (NICB), state fraud bureaus, and legal counsel.
• Collaborate with vendors, product managers, and digital teams to improve fraud detection rules, alerts, and analytical models.
• Ensure all investigative and analytical activities comply with applicable fraud laws, privacy regulations, and regulatory reporting requirements.

Skills

All-source intelligence

Data analysis

Communication skills

Insurance fraud knowledge

Autonomy

Education

Bachelor's degree in Criminal Justice

Tools

Investigative databases

Social media analysis

Data visualization tools

Job description

Jobgether, on behalf of our partner, seeks an SIU, Complex Major Case Investigator based in the United States. You will lead complex investigations into sophisticated insurance fraud schemes, synthesizing evidence from financial records, forensics, and sources to support claims decisions and regulatory actions.

Collaboration with Claims, Underwriting, and law enforcement, plus strong data-analysis and communication skills, are essential to disrupt fraud networks and uphold regulatory compliance