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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Fraud Investigations and Insurance Claims Investigations, utilizing strong Analytical and Critical Thinking skills to conduct thorough evaluations and documentation. Proficient in Evidence Gathering and Problem Analysis to support decision-making in complex claims.
Highest-signal resume keywords
Fraud InvestigationsInsurance Claims InvestigationsAnalytical ThinkingEvidence GatheringDocumentation
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Investigative SkillsDecision MakingProblem AnalysisTime ManagementInterviewing
Soft Skills
Critical Thinking
Tools & Technologies
SIU SystemsAnalytic Tools
Industry Keywords
InsuranceSpecial InvestigationsClaims Processing
About the role
Key responsibilities & impact- Enter SIU claim data into multiple SIU systems
- Review investigations with fraud outcomes to validate whether denial is appropriate
- Update files with investigation outcomes and return files to market claim offices when no fraud or insufficient evidence is found
- Conduct complex online data application searches, research, and evaluation
- Conduct complex site inspections at body shops, medical clinics, loss locations, and other sites
- Conduct thorough investigations of potentially fraudulent claims, including scene investigations and surveillance as needed
- Validate information obtained through investigations and follow up on possible leads
- Summarize documents and enter claim system notes documenting evaluations and decision-making
- Use analytic tools and SIU field intelligence to identify complex claims and support evidence of fraud and damages
- Research and respond to complex customer communications, concerns, conflicts, or issues
- Service the broader Northern California region
Requirements
What you’ll need- Preferred candidate based in or around San Francisco, Oakland, San Jose, Sacramento, or surrounding commuting areas
- Strong background in investigations and insurance
- Analytical Thinking
- Critical Thinking
- Decision Making
- Documentation
- Evidence Gathering
- Fraud Investigations
- Insurance Claims Investigations
- Interviewing
- Investigative Skills
- Problem Analysis
- Special Investigations
- Time Management
- Authorization to work in the United States
- Must have a dedicated, private workspace free from distractions
- Appropriate desk and seating for working from home
- Reliable internet with minimum speeds of 50 MB download and 5 MB upload
Benefits
Comp & perks- Incentive pay (commission, bonus, etc.) if applicable
- Comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse
- Monthly connectivity reimbursement to help offset internet costs for employees eligible to work from home
- Work-from-home arrangement
- Equal opportunity employment and consideration regardless of protected characteristics
