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Major Case Investigator
Central Insurance. Conduct extensive and detailed investigations of high-complexity suspicious losses or organized schemes involving staged accident rings, medical provider treatment and billing rings, and general contractors including public adjusters, roofing, and mitigation companies .
About the role
Key responsibilities & impact- Conduct extensive and detailed investigations of high-complexity suspicious losses or organized schemes involving staged accident rings, medical provider treatment and billing rings, and general contractors including public adjusters, roofing, and mitigation companies
- Partner with SIU and line-of-business claims personnel to determine whether to initiate organized scheme investigations
- Assist in developing training and provide fraud awareness training and technical advice to internal stakeholders
- Develop and execute investigation strategies for complex assigned cases, particularly organized or ring-related cases
- Gather and evaluate data from multiple internal and external sources to identify and investigate potential fraudulent insurance acts involving Central policies
- Lead in-depth interviews of insureds, witnesses, medical professionals, claimants, and other parties associated with claims
- Complete detailed investigations in adherence with SIU procedures and best practices
- Establish relationships and present cases to Departments of Insurance, NICB, state, local, and federal law enforcement, medical boards, Departments of Professional Licensing, and other necessary departments
- Seek potential sources of prosecutorial or administrative action, including the Better Business Bureau, Federal Trade Commission, State Attorney General, and other entities
Requirements
What you’ll need- Bachelor's degree and 4 years of investigative/Law Enforcement or insurance investigation experience, or 6 years of investigative/Law Enforcement or insurance investigation experience
- Ability to travel as assigned
- Advanced practical knowledge of conducting clinic inspections and field investigations
- Extensive network with law enforcement agencies and ability to collaborate on investigations of suspicious losses
- Ability to analyze and interpret complex and voluminous evidence and convey highly technical information effectively
- Strong knowledge of CPT codes and fraudulent billing practices, including up coding, unbundling, and inflated practices
- Ability to prepare and submit detailed investigative reports and make investigative recommendations
- Demonstrated ability to conduct extensive and complex suspicious loss investigations and/or lead organized scheme investigations
- Ability to understand Central Insurance's policies and processes
Benefits
Comp & perks- Comprehensive total rewards package supporting financial, health, career, and retirement objectives
- Extensive health and wellness benefits
- Flexibility and work-life balance support
- Long-term financial security support