Conducts thorough field investigations and analyzes evidence to determine whether or not fraud has occurred. Defends the company against fraudulent claims and activity, and acts as a technical expert providing investigative expertise and assistance both on an individual and team basis.
•Investigates special investigation unit claims to include:
uninsured motorist property damage exposures, disputed cancellations, disputed policy in-force, thefts, burned vehicles, single/multiple party losses, questionable damage claims, low-impact losses, loss operating expense claims, prior losses, questionable referrals, first/third party injuries, pre-text claims, provider investigations, complex multi-carriers task force investigations and nation crime information center status.
•Analyzes results of investigations to determine course of action; documents activities of injury and material damage claims handling practices.
•Conducts in-person interviews and obtains detailed in-person recorded statements from all involved parties.
•Requests, prepares, documents, conducts examinations under oath and/or sworn statements including those involving attorney representation.
•Conducts thorough searches using insurance investigative databases, internal resources such as Intellishare, 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.
•Renders opinions on investigative findings through written reports and recommends whether to take further actions.
•Completes vehicle inspections and obtains fluid samples to investigate alleged damages in relationship to loss.
•Conducts clinic inspections (state specific) and neighborhood canvases and on-scenes to include diagrams, measurements and/or light sequence.
•Analyzes vehicle photos to investigate alleged damages in relationship to loss.
•Testifies at depositions, hearings and trials.
•Develops and maintains a rapport with local information networks to include law enforcement, vendors and industry experts.
•May conduct branch training.
•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 under pressure and within a collaborative team oriented environment using sound judgment in decision-making.
•Excellent communication skills both oral and written with strong analytical skills to effectively investigate suspected insurance fraud
•Excellent customer service and solid negotiation skills.
•Demonstrated proficiency with Microsoft Office products (Excel, PowerPoint, and Word) and claims related software programs.
•Demonstrated knowledge of coverage, policy interpretation, exposure recognition and liability determination to analyze and move investigations forward.
•Understands and able to interpret property damage and bodily injury claims terminologies and processes.
•Must be able to travel daily within assigned geographical areas.
Experience / Education:
•Bachelor’s degree in Business Administration, a related field, and/or equivalent education required.
•Three years special investigation unit insurance experience and/or detective/investigator within law enforcement preferred.
•Property damage experience preferred.
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