SIU Field Investigator

Kentucky Bar Association; United States; Remote; USD 72,000 - 102,000; Full time

Job summary

A leading organization in legal services seeks a seasoned Fraud Investigator to join their Special Investigations Unit. This field-based position in Los Angeles involves comprehensive investigations of complex claims with potential fraud, mentorship responsibilities, and analytical reviews. Ideal candidates should have a strong investigative background in insurance and law enforcement.

Qualifications

• Preferred 4-year Bachelor's Degree.
• Preferred 2+ years of relevant experience.

Responsibilities

• Conduct thorough investigations including background searches and scene inspections.
• Perform online data searches and document findings in claim system notes.
• Analyze investigations with fraud outcomes to validate claims.

Skills

Investigative skills

Analytical thinking

Education

Bachelor's Degree

Job description

This job is responsible for investigating and analyzing complex, multi-discipline coverage and claims that have been referred to the special investigation unit (SIU) for potential fraud. This role typically handles a combination of complex attorney-represented and unrepresented claims and moderate to complex losses, in which suspicious activity has been identified. The individual performs thorough investigations including:

1. Conducting background searches, scene investigations, and clinic inspections;
2. Taking recorded statements;
3. Reviewing and analyzing medical notes, bills, and property damage;
4. Conducting witness interviews and social media searches.

The individual may conduct surveillance on property and/or create scene reconstructions on some investigations and reviews whether fraud can be substantiated to support a lawsuit. They also provide guidance and mentorship to less experienced team members.

This is a field-based position within our Special Investigations Unit (SIU) Fraud Investigation Department, responsible for conducting complex field fraud investigations. The ideal candidate must reside in or around Los Angeles, California. We seek candidates with a strong background in investigations, ideally across multiple lines of insurance coverage. A background in law enforcement or a similar investigative field is highly preferred.

The role involves:

• Reviewing investigations with fraud outcomes to validate whether denial is appropriate;
• Conducting complex site inspections (e.g., body shops, medical clinics, loss locations);
• Performing online data searches, research, and evaluation;
• Verifying the accuracy of information obtained through investigation and following up on leads;
• Entering SIU claim data into multiple systems;
• Updating investigation files and returning files to MCO when no fraud is found;
• Conducting thorough investigations of potentially fraudulent claims, including scene investigations and surveillance as needed;
• Using analytic tools to identify complex claims for investigation and support in evidence gathering;
• Documenting findings and decisions in claim system notes;
• Responding to complex customer communications and concerns.

Qualifications include:

• 4-year Bachelor's Degree (preferred);
• 2 or more years of relevant experience (preferred);

This job does not have supervisory responsibilities. The base compensation ranges from $72,890 to $101,365 annually, depending on experience and qualifications.