SIU, Complex Major Case Investigator

Accountabilities

You will lead complex investigations and contribute to broader fraud intelligence initiatives, ensuring that suspicious activity is identified, thoroughly documented, and addressed through effective collaboration and compliant investigative practices.

• Investigation and Case Management

  • Conduct complex investigations into suspected fraudulent claims and schemes involving claimants, healthcare or service providers, policyholders, and internal parties.

  • Collect, preserve, and analyze evidence from multiple sources, including financial records, digital forensics, surveillance, social media, and public or private databases.

  • Prepare detailed, accurate, and concise investigative reports to support internal claims decisions, law enforcement referrals, and courtroom proceedings.

  • Manage an active caseload independently while collaborating with colleagues to meet deadlines and investigation objectives.

  • Intelligence and Data Analysis

    • Monitor fraud activity across products and channels, using statistical analysis to identify emerging patterns, trends, and systemic vulnerabilities.

    • Apply all-source intelligence research, collection, and analysis techniques to identify fraudulent networks, key individuals, and their methods.

    • Evaluate new data sources and investigative vendor tools to uncover emerging fraud patterns and improve predictive models and detection strategies.

    • Deliver timely intelligence briefings to leadership on fraud trends, investigative tools, and the evolving threat landscape.

    • Collaboration and Fraud Disruption

      • Work closely with Claims, Underwriting, and Audit teams to provide investigative expertise and coordinate fraud response strategies.

      • Serve as a liaison with external partners, including law enforcement, regulatory agencies, the National Insurance Crime Bureau (NICB), state fraud bureaus, and legal counsel.

      • Collaborate with vendors, product managers, and digital teams to improve fraud detection rules, alerts, and analytical models.

      • Compliance and Integrity

        • Ensure all investigative and analytical activities comply with applicable fraud laws, privacy regulations such as the Gramm-Leach-Bliley Act (GLBA), and regulatory reporting requirements.

        • Maintain strict confidentiality and uphold the highest standards of professional ethics and investigative integrity.

        Requirements

        The successful candidate will bring substantial experience in complex insurance fraud investigations, law enforcement, or intelligence analysis, supported by strong analytical capabilities and sound investigative judgment.

        • Bachelor's degree in Criminal Justice, Data Analytics, Intelligence Studies, or a related field.

        • 5–7 years of professional experience in complex insurance fraud investigations, particularly in Commercial Insurance, Property and Casualty (P&C), or Workers' Compensation, or in law enforcement or intelligence analysis.

        • Demonstrated expertise in all-source intelligence gathering and analytical techniques applied to complex investigations.

        • Strong analytical and quantitative skills, including the ability to interpret large datasets, identify patterns, and make evidence-based decisions.

        • Proficiency with investigative databases, social media analysis, and data visualization tools is highly preferred.

        • Excellent written and verbal communication skills, with the ability to present complex findings clearly to different audiences.

        • Ability to work autonomously, demonstrate initiative, and exercise sound judgment and discretion.

        • Strong understanding of insurance principles, fraud statutes, and privacy regulations.

        Benefits

        • Expected annual salary range of $105,000–$110,000.

        • Competitive compensation package.

        • Medical and dental insurance plans.

        • Life insurance coverage, including eligible spouses and children.

        • Healthcare Flexible Spending Account (FSA).

        • Dependent Care Flexible Spending Account.

        • 401(k) savings plan.

        • Paid time off.

        • Opportunities for career advancement.

        • Commitment to a diverse and inclusive workplace that values different backgrounds, skills, and perspectives.