Senior Claims Investigation and Fraud Prevention Analyst

. Receive, record, and conduct the initial triage of investigation requests submitted by the Claims team .

Posted 10/16/2026full-timeSão Paulo • BrazilSeniorWebsite

Key responsibilities & impact

Receive, record, and conduct the initial triage of investigation requests submitted by the Claims team
Manage the complete workflow of cases under investigation, ensuring organization, traceability, and demand control
Monitor and control SLAs for investigations, investigative inquiries, and report deliverables
Define and monitor investigative strategies together with partner investigation firms
Validate questionnaires and guidelines for field interviews
Provide technical guidance to vendors on investigative procedures and expected quality standards
Monitor investigative inquiries conducted by third-party firms, ensuring that the necessary evidence is obtained
Assess the evidentiary quality and materiality of evidence produced during investigations
Conduct critical reviews of submitted reports, ensuring objectivity, completeness, and alignment with the investigative inquiries performed
Identify inconsistencies, quality deficiencies, and SLA deviations, implementing corrective actions with vendors
Work closely with Fraud Prevention and Claims teams to align priorities and support decision-making
Prepare management reports and monitor operational metrics related to investigations
Ensure compliance with the investigation standards, procedures, and best practices adopted by the client

What you’ll need

Experience in insurance fraud prevention
Background in claims adjusting, claims analysis, fraud prevention, or claims investigation
Experience managing investigative vendors or partners
Knowledge of the claims analysis and investigation workflow
Ability to evaluate evidence, investigative reports, and materiality
Highly organized, analytical, and process-oriented profile
Experience monitoring metrics, operational controls, and SLAs
Proficiency in Microsoft Office, especially Excel
Preferred: experience conducting claims investigations for insurance companies
Preferred: experience in Compliance, Investigative Audit, or Fraud Prevention
Preferred: experience managing outsourced investigation teams
Preferred: knowledge of Power BI
Preferred: experience preparing executive reports and supporting operational governance

Comp & perks