Senior Special Investigator

Scottsdale, AZ

Scottsdale Insurance Company

JOB SUMMARY:  

Independently conducts complex investigations of suspicious or unlawful activity directed at policyholder and corporate assets in a prompt and expeditious manner. Continuously monitors suspicious claims and claims payment operations in pursuit of fraudulent activities and the prevention of future fraudulent payments. 

JOB RESPONSIBILITIES:

1.  Investigates assigned claims suspected of insurance fraud, this includes but is not limited to, PIP, large loss, large loss fire, and multiple claims. Geographic location may impact work load.

2.  Performs as the primary Investigator in a multi-state major case investigation when selected by senior leadership.

3.  Maintains assigned claims files in a confidential manner; documents all relevant facts pertaining to files in the appropriate claims handling system(s).

4.  Independently concludes investigations in adherence to Special Investigation Unit Best Practices.  May utilize expertise of an outside vendor to assist with investigation and consult with a large loss specialist.

5.  Proactively provides support to claims partners which may include, data mining, analyzing and trending claims information and claims consultation/training on claims and investigative changes/impacts leading to increased awareness of suspicious claims.  Ensures that assigned cases are investigated and reported back to the requesting party in adherence to Special Investigation Unit Best Practices

6.  May provide investigative guidance to Special Investigator team members.

7.  Regularly attends/initiates meetings with Claims Management.  May attend Claim Leadership Team meetings.

8.  Keeps management informed of developments that impact claims results in assigned region.

9.  Produces investigative reports for Special Investigation Unit Manager and customers through data mining, pattern analysis and trending claims information.

10.  Anticipates training needs of customers based on customer exposure and antifraud initiatives. May partner with Special Investigation Unit Training to develop and deliver customer training to maintain fraud awareness.

11.  Develops and maintains rapport and cooperation with federal, state and local government agencies, as well as private information bureaus that can assist in investigative efforts.

12.  Represents Nationwide by testifying in civil and criminal court proceedings as needed.

13.  Maintains and pursues technical competency within area of specialization by attending insurance fraud seminars and other company-sponsored courses at the direction of the Special Investigation Unit Leadership.

14.  Submits expense reports and other administrative reports as required and maintains assigned company equipment.

15.  Acts in accordance to Nationwide Core and Performance values.

16.  Performs other duties as assigned.

JOB REQUIREMENTS:

Education: 

Undergraduate studies in insurance, law, criminal justice or business preferred.

Knowledge: 

Knowledge of claims business operations including claims process, procedures, best practices, and service levels. Must possess knowledge of Property/Casualty Insurance, such as organization, structure, channels, and business focus for the Special Investigation Unit organization and company.  Demonstrated knowledge of current investigative trends and awareness of potential developments impacting Special Investigation Unit.  Comprehensive knowledge of State Fraud Statutes and Policy contracts across all businesses (e.g. Property, Casualty, Commercial).

Experience: 

5-8 years experience in special investigations involving insurance investigations, private investigations or law enforcement investigations and/or Property/Casualty field claims handling experience.

Skills/Competencies: 

Oral and written communication skills for interaction with vendors, other SIU associates, SIU management, and other areas of claims; negotiation skills for vendor management, program management and/or claims quality calibration.

JOB CONDITIONS:

Overtime Eligibility: Not Eligible (Exempt).

Working Conditions:

Normal office environment.  Travel required.  May be exposed to potentially hazardous situations.  Representatives may be required to operate an automobile and have a valid driver's license with a safe driving record.

Credit Check:  D

Due to the fiduciary accountability within this job, a valid credit check and/or background check will be required as part of the selection process.

ADA: 

The above statements cover what are generally believed to be principal and essential functions of this job.  Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.