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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in fraud investigation strategies, including knowledge of insurance products, state laws, and regulations. Proficient in evidence collection, report preparation, and risk management within the insurance industry.
Highest-signal resume keywords
Fraud InvestigationP&C Adjuster's LicenseEvidence GatheringRisk ManagementInsurance Industry Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Fraud Scheme AnalysisInvestigative ReportingData AnalysisCase Law FamiliarityClaims HandlingForensic Tools ProficiencyRegulatory ComplianceInterview TechniquesEvidence CollectionMedical Terminology Knowledge
Soft Skills
Organizational SkillsProblem-SolvingCommunication SkillsRelationship BuildingTraining Delivery
Tools & Technologies
Investigative DatabasesData Extraction SoftwareComputer Proficiency
Certifications & Qualifications
Bachelor's DegreeP&C Adjuster's License
Industry Keywords
Insurance FraudP&C InsuranceFraud Prevention StrategiesLitigated ClaimsCompliance Policies
About the role
Key responsibilities & impact- Applies knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third-party claims.
- Participates in the development of fraud prevention strategies.
- Applies knowledge of insurance industry products, services and processes in investigating claims. This includes insurance policy contracts, coverages and internal claims handling process and procedures.
- Applies knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
- Collects evidence of potential fraud through remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.
- Makes recommendations within defined authority guidelines.
- Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results of the investigation and recommended outcome.
- Establishes and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection and prevention.
- May serve as a resource team member on specific matters through demonstrated skill or training.
- Assists with the delivery of fraud awareness training initiatives in a defined environment.
- Handles CAT duty responsibilities as business requires.
- Identifies and handles existing and emerging risks that stem from business activities and the job role.
- Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled.
- Follows written risk and compliance policies and procedures for business activities.
Requirements
What you’ll need- Bachelor's degree in a related field or equivalent relevant education.
- A minimum of 4 years of comprehensive experience in P&C SIU/Fraud investigations or 6 years in a related fraud industry investigation role.
- Demonstrated knowledge and understanding of fraud investigations, including familiarity with case law, state laws, and regulations.
- Ability to obtain or possess a P&C adjuster's license within 90 days of employment.
- Track record as an investigator with experience in conducting statements involving multiple parties.
- Proficiency in gathering evidence and making conclusions based on objective details related to fraud applicability.
- Ability to effectively organize and prioritize workloads, handle multiple tasks, and devise solutions for problems.
- Proficiency in using computers and software packages to input and extract data for analysis from pertinent data sources and systems.
- Knowledge of city, state, and local regulations, legal principles, contract understanding, case law, medical treatment, and medical terminology.
- Experience in managing specialty/complex/litigated claims and cases.
Benefits
Comp & perks- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options