Conduct objective, fair, thorough, unbiased and timely investigations into allegations of fraud, waste or abuse committed by clients against our company.
Review and research evidence/documents to analyze the overall fact pattern of claim and synthesize data into a professional report with recommendations.
Prepare and coordinate field assignments to obtain relevant evidence and information.
Coordinate with defense attorneys to provide deposition strategies and use law enforcement resources for assistance.
Manage and prioritize a large and varied case load effectively and efficiently to achieve positive results.
Prepare prosecution packages and restitution proposals.
Qualifications
Proven working experience in related field.
Strong interpersonal and communication skills including the ability to interact with clients, upper management and law enforcement.
Ingenuity and persistence to obtain case information not readily available with an eye for detail.
Ability to work independently with minimum supervision.
Good organizational skills needed to manage a high volume of assigned cases.
Proficient with the insurance procedures, regulations and investigation methods.
Hands on experience with relevant Information System.
Display good interviewing and interrogation skills along with the capability of drafting reports.
Honest and ethical with high levels of integrity and confidentiality.
Willing to submit to extensive background checks and provide. employment recommendations.
BS degree in a related field (e.g. insurance studies, criminal justice, risk management) or other relevant certification preferred (e.g. Certificate of Insurance Fraud Investigator).