Fraud Investigator (Hybrid)

The Fraud Investigator conducts investigations and reports suspected instances of insurance fraud. They review and research evidence and documents to analyze the overall fact pattern of claim and synthesis data into professional reports with recommendations.

• →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.

• 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.

• Working 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.
• Technical proficiency with cameras, computers, recorders, and all SIU resource materials.
• Good computer skills including electronic email and databases.
• Proficient Microsoft Word and Excel skills.
• Organized; detail oriented; investigative thought process.
• Excellent communication skills including verbal and written and active listening.
• Ability to work independently and take direction.
• Ability to analyze data to identify leads and potential investigations.
• Ability to at times work in less-than-ideal situations and locations while performing investigations.