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.
***This position will encompass the San Francisco Bay area as well as the Central Valley.
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.
- Investigates special investigation unit claims to include:
- 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.
Experience / Education:
- 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.
- 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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