Senior Special Investigator

Assurant, Inc.; United States; On-site; USD 85,000 - 130,000; Full time

Job summary

Assurant, Inc. seeks a Senior Special Investigator to protect assets by detecting and preventing fraudulent claims. You will conduct complex interviews, manage high-exposure cases, and apply detailed knowledge of P&C products, policies, and state regulations across multiple entities.

The role involves reviewing medical and legal documents, coordinating with law enforcement, and leading investigations while maintaining confidential files. Florida experience is a plus for the regional focus.

Qualifications

• 10+ years of P&C SIU/Fraud investigation experience or relevant fraud investigation; or 10+ years law enforcement
• Bachelor’s Degree in Criminal Justice or related field desired
• CFE/CIFI/FCLS designations a plus

Responsibilities

• Conduct timely investigations of suspected fraudulent claims to ensure prompt decisions
• Lead high-profile investigations across entities and functions
• Apply advanced knowledge of P&C insurance policies and regulations to fraud cases
• Gather and document evidence from interviews, records, and public sources
• Initiate referrals to fraud bureaus and state authorities when fraud is identified
• Testify at depositions, hearings, and trials
• Maintain confidential claims files and investigate budgets with vendors

Skills

Investigation experience

Attention to detail

Analytical thinking

Communication skills

Independent work

Education

Bachelor’s Degree in Criminal Justice

Professional designations (CFE/CIFI/FCLS)

Tools

Microsoft Office

Claims software

Job description

The Senior Special Investigator protects the assets of the organization by avoiding the payment of fraudulent claims in accordance with the applicable law and policy provisions. SIU gathers facts of the loss without exposing the company to bad faith damages.

What will be my duties and responsibilities in this job?

• Conducts timely investigations of suspected fraudulent claims to ensure a prompt and accurate claims decision.
• Conducts complex recorded interviews and investigations in an effort to validate a claim or identify persons or organizations that are involved in suspicious related activities.

• Leads high exposure, high profile and sensitive work assignments, and special investigations involving complex specialized fraud referrals, (examples: organized provider rings, staged accidents, large losses of significant exposure and broad scale P&C schemes) across multiple entities or functions-Major Cases.
• Applies advanced knowledge of P&C insurance industry products, services, and processes in investigating claims. This includes P&C insurance policy contracts and coverages and claims handling process and procedures.
• Applies advanced knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
• Processes large quantities of unstructured detailed information with high levels of accuracy by collecting evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools, in order to validate the company’s exposure.

• Maintains assigned claims files in confidential manner and ensures that all relevant facts pertaining to the files are documented in the appropriate claims handling system.
• Initiates referrals to State Insurance Department, Fraud bureaus and NICB when a suspicious or fraudulent activity has been identified.
• Initiates civil/criminal actions based on investigative outcomes.
• Maintains investigative databases.
• Assist all Assurant subsidiaries and accounts with investigations.
• Conducts Fraud Training for new hires, clients and company staff as needed.
• Assist SIU Manager with Claims Assignment as needed.
• Requests, prepares, documents, and may conduct Examinations under Oath and/or sworn statements including those involving attorney representation.
• Conducts thorough searches using investigative databases, internal resources, internet resources, and public records to locate parties and collect evidence to determine if potential fraud exists.
• Obtains, evaluates and summarizes law enforcement reports, credit reports, medical documentation and affidavits in relation to loss including documentation from required parties in accordance to state and federal regulations.
• Reviews and interprets medical records, reports, and billing in relation to injury loss investigations.
• Testifies at depositions, hearings, and trials.
• Develops and maintains a rapport with local information networks to include law enforcement, vendors, and industry experts.
• Handles budgeting and directs outsourced investigations to vendor partners.
• Acts as a resource to other Special Investigators.

What are the requirements needed for this position?

• 10+ years of P&C SIU/Fraud investigation experience or relevant fraud industry investigation experience, or at least 10 years prior law enforcement investigative experience/detective rank.
• Knowledge of Florida Property Fraud preferred.
• Bachelor’s Degree in Criminal Justice or relevant work experience desired.
• CFE/CIFI/FCLS designations a plus.
• Field Investigation experience.

• Detail-oriented with strong organizational skills, able to work well under deadlines in a changing environment and perform multiple tasks effectively and concurrently.
• Demonstrated ability to manage relationships with both internal and external customers.
• Demonstrated ability to work effectively independently and within a collaborative team-oriented environment using sound judgment in decision-making.
• Excellent communication skills both oral and written skills with strong analytical skills.
• Demonstrated proficiency with Microsoft Office products (Excel, PowerPoint, and Word) and claims related software programs.
• Must be a results-oriented, skilled investigator with experience taking complex statements from multiple parties to an event.
• Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.
• Proven ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems.

• Must be able to handle high volume of investigations and remain timely on status reports.
• Ideal candidate will reside in Florida.