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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in conducting complex fraud investigations across Auto, Homeowners, and Specialty Lines, utilizing analytic tools and investigative techniques to validate claims and support legal actions. Possesses strong communication skills to manage customer concerns and document investigation outcomes effectively.
Highest-signal resume keywords
Investigative ExperienceSpecial Investigations Unit (SIU) BackgroundFraud Investigation ExpertiseActive Insurance LicenseAnalytic Tools Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Fraud InvestigationClaims AnalysisBackground SearchesScene InvestigationsMedical Notes ReviewClaim Decision-MakingData Application SearchesEvidence ValidationCustomer Issue ResolutionDocument Summarization
Soft Skills
CommunicationConflict ResolutionAttention to DetailAnalytical ThinkingProblem-Solving
Tools & Technologies
SIU SystemsAnalytic ToolsClaim Systems
Certifications & Qualifications
Active Insurance License
Industry Keywords
Fraud DetectionClaims ManagementAuto InsuranceHomeowners InsuranceSpecialty Lines
About the role
Key responsibilities & impact- Investigate and analyze complex and occasionally highly complex, multi-discipline coverage and claims referred to SIU for potential fraud
- Conduct background searches, scene investigations, clinic inspections, recorded statements, witness interviews, and social media searches
- Review and analyze medical notes, bills, property damage, and other claim evidence
- Determine whether fraud can be substantiated and support lawsuits
- Conduct fraud investigations across Auto, Homeowners, and Specialty Lines
- Make claim decisions regarding complex investigations and pursue restitution
- Manage, research, and resolve complex customer communications, concerns, conflicts, and issues
- Validate information obtained through investigations and follow up on leads
- Use analytic tools and SIU field intelligence to identify claims for investigation and support evidence of fraud and damages
- Summarize documents and enter claim system notes, evaluations, and decision-making processes
- Enter SIU claim data into multiple SIU systems
- Update files with investigation outcomes and return files to MCO for further handling when fraud is not found or evidence is insufficient
- Review fraud-outcome investigations to validate whether denial is appropriate
- Conduct online data application searches, research, and evaluation
- Support a territory within approximately a three-hour radius of Chicago, Illinois
Requirements
What you’ll need- Prior investigative experience required
- Strong preference for Special Investigations Unit (SIU) background
- Proven track record of identifying, investigating, and resolving suspicious claims
- Experience conducting complex fraud investigations across Auto, Homeowners, and Specialty Lines
- Candidates must possess authorization to work in the United States
- Active insurance license holders must terminate all existing appointments before onboarding and must not hold outside appointments during employment
- Applicants seeking an adjuster role who hold a resident producer license must surrender that license when instructed by the licensing team
- Dedicated, private workspace free from distractions when working from home
- Reliable internet with minimum speeds of 50 MB download and 5 MB upload
Benefits
Comp & perks- Comprehensive technology setup including a laptop, monitors, headset, keyboard, and mouse
- Monthly connectivity reimbursement for employees eligible to work from home
- Dedicated, private workspace requirement for home working
- Equal employment opportunity protections
- Work authorization support is not provided; candidates must be authorized to work in the United States