SIU, Complex Major Case Investigator

The SIU – Complex Major Case Investigator is a cornerstone of our fraud defense strategy. This role moves beyond traditional case investigation to proactively identify, analyze, and dismantle complex fraudulent networks targeting the organization. By leveraging all-source data, advanced analytics, and collaborative partnerships, this position provides actionable intelligence that protects company assets, ensures regulatory compliance, and supports high-stakes legal proceedings. The ideal candidate is an expert in both investigative techniques and data interpretation, capable of turning raw information into strategic insight.

ResponsibilitiesInvestigation & Case Management· Conduct complex investigations into suspected fraudulent claims and schemes involving claimants, providers, policyholders, and internal parties.· Gather, preserve, and analyze critical evidence from a wide array of sources, including financial records, digital forensics, surveillance, social media, and public/private databases.· Prepare detailed, clear, and concise investigative reports suitable for internal claims decisions, law enforcement referrals, and courtroom testimony.· Manage a dynamic caseload efficiently, working both independently and as a collaborative team member to meet deadlines and objectives. Intelligence & Data Analysis:· Proactively monitor fraud activity across all products and channels, applying statistical analysis to identify emerging patterns, trends, and systemic vulnerabilities before they escalate.· Apply all-source research, collection, and analysis techniques to illuminate fraudulent networks, their key players, and methodologies.· Continuously evaluate new data sources and vendor tools to uncover novel fraud patterns and enhance the evolution of our predictive models and fraud detection strategies.· Provide timely and actionable intelligence briefings to leadership on fraud trends, tool effectiveness, and the overall threat landscape. Collaboration & Disruption:· Collaborate closely with Claims, Underwriting, and Audit departments to provide investigative expertise and ensure a cohesive strategy.· Serve as a key liaison with external partners, including law enforcement, regulatory agencies (NICB, state fraud bureaus), and legal counsel, to disrupt and dismantle fraudulent networks.· Partner with vendors, product managers, and digital teams to refine and improve the accuracy of fraud detection rules, alerts, and analytical models. Compliance & Integrity:· Ensure all investigative and analytical activities are conducted in strict compliance with relevant fraud statutes, privacy laws (e.g., GLBA), and regulatory reporting requirements.· Uphold the highest ethical standards, maintaining absolute confidentiality and integrity in all matters. #LI-EF1#LI-REMOTE

Qualifications· Bachelor’s degree in criminal justice, data analytics, intelligence studies, or a related field.· Minimum of 5-7 years of professional experience in complex insurance fraud investigations (Commercial, P&C, Workers' Compensation), law enforcement, or intelligence analysis.· Demonstrated expertise in conducting all-source intelligence gathering and applying analytical techniques to complex investigations.· Strong analytical and quantitative skills with a proven ability to interpret large datasets, identify patterns, and make data-driven decisions.· Proficiency with investigative databases, social media analysis, and data visualization tools is highly preferred.· Exceptional written and verbal communication skills, with the ability to present complex information clearly to diverse audiences.· Proven ability to operate with a high degree of autonomy, initiative, and discretion.· A strong understanding of insurance principles, fraud statutes, and privacy regulations.  The expected salary range for this role is $105-110k   Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations