Senior Consultant

CNA Insurance

. Initiate and manage suspected provider fraud investigations involving highly complex medical, legal, and related matters within California .

Posted 10/16/2026full-timeWalnut Creek • California • United StatesSenior💰 $72,000 - $141,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates advanced knowledge of investigation and fact-finding practices, with a strong ability to analyze complex fraud schemes and apply relevant regulations. Capable of leading investigations, collaborating with stakeholders, and delivering training on fraud awareness and compliance.

Highest-signal resume keywords

Insurance Fraud InvestigationCalifornia RegulationsAdvanced Knowledge of Claim Handling PracticesProfessional Certification in Fraud InvestigationsMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigation TechniquesFact-Finding PracticesFraud Scheme AnalysisCPT Codes ApplicationB&P Codes ApplicationCase Record MaintenanceReport WritingProblem AnalysisSolution ImplementationVendor Management

Soft Skills

Interpersonal CommunicationDetail OrientationTime ManagementCollaborationJudgment and Decision-Making

Tools & Technologies

Microsoft Office ApplicationsRelational Database Querying

Certifications & Qualifications

CFECIFIFCLSFCLA

Industry Keywords

Insurance FraudCivil LitigationCriminal LitigationProperty and Casualty ClaimsFraud Awareness Training

About the role

Key responsibilities & impact

Initiate and manage suspected provider fraud investigations involving highly complex medical, legal, and related matters within California
Analyze complex fraud schemes and emerging trends, and apply California regulations, B&P Codes, CPT Codes, and other investigative tools
Provide advice, direction, and support to technical claim teams and counsel regarding detection, investigation, and litigation of suspected claims
Lead detailed, thorough, and timely investigations in accordance with Best Practice Guidelines
Collaborate with insureds, claimants, witnesses, experts, counsel, claim professionals, and other stakeholders
Develop and execute investigation strategies independently or collaboratively
Manage investigation activities and coordinate or oversee vendor service partner activities in the field
Maintain accurate case records and create comprehensive reports of investigative findings and conclusions
Recommend claim resolutions by presenting findings and proposing solutions
Identify and participate in process and procedural improvements
Develop and deliver fraud-awareness or regulatory-compliance training and mentor lower SIU staff
Prepare cases for outside agencies and pursue criminal or civil actions by gathering, documenting, organizing, and summarizing relevant facts
Testify on behalf of the company in civil or criminal matters when required
Maintain current knowledge of insurance-fraud law, regulations, trends, and emerging issues
Participate in insurance-fraud or related professional associations

Requirements

What you’ll need

Bachelor’s degree or equivalent professional experience
Minimum of eight (8) years of experience conducting or directing investigations in insurance fraud, law enforcement, civil or criminal litigation, or a similar field
Advanced knowledge of property and casualty claim handling practices
Superior or expert technical knowledge of investigation and fact-finding practices and techniques
Excellent interpersonal, oral, and written communication skills
Ability to synthesize and communicate complex issues to all organizational levels
Ability to interact and collaborate with internal and external business partners, including outside agencies
Ability to work independently, exercise good judgment, make sound business decisions, and develop others
Strong organization, detail orientation, and time management skills
Ability to analyze highly complex, ambiguous problems and develop and implement effective solutions
Proficiency with Microsoft Office applications and similar business software
Understanding of relational database information-querying techniques
Ability to lead change while valuing diverse opinions and ideas
Ability to implement proactive, long-term strategies supporting business objectives
Professional certification or designation related to fraud investigations strongly preferred (e.g., CFE, CIFI, FCLS, FCLA, or similar)
Advanced degree highly desired

Benefits

Comp & perks

Comprehensive and competitive benefits package
Benefits supporting employees’ and family members’ physical, financial, emotional and social wellbeing goals
Reasonable accommodations for qualified individuals with disabilities in the recruitment process