Investigator

• Investigate suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines of business.
• Work independently and collaboratively with internal stakeholders and external partners to evaluate and investigate suspicious insurance transactions (claims, underwriting, policy, etc.), collect evidence, support fraud detection programs, and communicate investigative findings to internal and external partners, regulators, and law enforcement.
• Support fraud detection and investigation by identifying red flags, gathering facts, and documenting evidence in compliance with company policy and legal requirements.
• Review claim files for basic red flags (inconsistencies, late reporting, coverage anomalies, questionable damages, medical billing issues).
• Conduct and lead thorough investigations of suspect, high exposure, and complex insurance claims and underwriting/policy concerns, including personal, commercial, and specialty lines of business – including property, auto, workers compensation, and other coverage types.
• Prepare detailed investigative reports for internal decision-making; support referrals to law enforcement or legal action when necessary, and where applicable to state fraud bureaus.
• Maintain thorough documentation of investigative actions and work product in accordance with accepted SIU operating standards and best practices.

Senior Investigator handling insurance fraud investigations for West Bend.

Senior Investigator – Special Investigations Unit, Illinois, Indiana, Michigan

Senior Investigator handling insurance fraud investigations across Illinois, Indiana, and Michigan for a top workplace. Collaborating with internal and external partners to evaluate suspicious transactions.

• Investigate complex cases involving phishing, blockchain exploits, hacks, terrorism finance, account takeovers, scams, money laundering, ransomware, and other illicit use of blockchain technology.
• Produce insightful reports and deliver them in writing and in briefings to TRM's customers.
• Conduct long-term research on key categories of on-chain crime, turning it into intelligence TRM's partners can act on.
• Support sensitive and complex investigations for TRM's public and private sector partners.
• Proactively identify, build, and manage relationships with industry partners to add new sources of attribution to TRM's pipeline at scale.

Global Investigator at TRM Labs conducting blockchain investigations and analysis

Global Investigator

Global Investigator at TRM Labs conducting blockchain investigations and complex case analyses. Collaborating with teams to provide intelligence solutions for clients in public and private sectors.

• Conduct timely investigations including recorded statements and interviews of claimants, witnesses, and employers.
• Provide timely status updates to case manager and client.
• Timely and clear documentation of the claim files.
• Maintain highest level of confidentiality and professionalism.
• Develop appropriate investigative action plan.
• Ensure accuracy, quality and timeliness of the evidence gathered during an investigation as well as compliance with all applicable laws, legal codes, and governing agencies.
• Provide Claim Adjuster with timely investigation results and document investigative findings.
• Determine whether additional evidence is required including but not limited to accident reports, accident scene reconstructions, witness statements, police reports, expert opinion, etc.
• Provide recommendations and decisions surrounding investigative efforts.
• Perform detailed database queries on SIU investigations to include analysis and organization of critical data to assist during the assigned investigation.
• Be able to evaluate State compliance referrals, as applicable, when questionable or suspicious activity is identified.
• Maintain active membership in professional organizations that provide SIU assistance and resources.
• Establish and maintain relationships with law enforcement, government regulatory agencies and insurance industry personnel assisting when needed or required.

SIU Investigator conducting insurance investigations in Chicago area

SIU Investigator

SIU Investigator conducting insurance claims investigations including fraud prevention and detailed reporting in Chicago area. Essential skills include strong investigative abilities and communication.

• Conducts a thorough search in the investigation of fires that are suspected of arson to determine the cause and origin of a fire.
• Examines the interior and exterior of buildings, cars, etc., for signs of forcible entry.
• Investigates the interior and exterior of buildings, cars, etc., for means of access.
• Creates photographs and videography of the fire scene, i.e. actual remains, debris, and bystanders.
• Determines the method, materials, motive, and malefactor of the arson.
• Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.

Arson Investigator I conducting arson investigations at the Illinois State Fire Marshal.

Arson Investigator I

Arson Investigator I conducting thorough fire investigations for the Illinois State Fire Marshal. Seeking experienced investigators to determine causes and origins of suspected arson fires.

• Responsible for the identification, investigation and development of cases against perpetrators of healthcare fraud
• Claim reviews for appropriate coding, data mining, entity review, law enforcement referral
• Responsible for identifying and developing enterprise-wide specific healthcare investigations
• Effectively establish rapport and on-going working relationship with law enforcement
• May assist in training of internal and external entities

Investigator II responsible for healthcare fraud investigation and claim reviews

Investigator II

Investigator II investigating healthcare fraud and conducting claim reviews across multiple health plans. Collaborating with law enforcement and assisting in policy development for preventive measures.

• Case Intake & Triage: Review alerts, referrals, and claims for indicators of fraud or suspicious activity, including misrepresentation, forgery, beneficiary fraud, and agent/distributor misconduct.
• Independently prioritize and triage the SIU’s cases based on risk, severity, exposure, regulatory deadlines and reputational risk.
• Establish and maintain accurate, audit-ready case logs and documentation standards in accordance with internal procedures and regulatory guidelines.
• Manage a concurrent caseload of complex, high-value investigations from intake through resolution, often serving as escalation point for cases initiated by other team members.
• Interpersonal and presentation skills to communicate, and represent the SIU, with internal and external sources.
• Comfort operating in a small or scaling team, including contributing to process design and program build-out rather than relying solely on existing infrastructure.
• Investigation Conduct & Leadership: Lead and independently manage end-to-end fraud investigations involving life insurance claims, policy procurement, and distribution channel activity, including multi-jurisdictional or organized fraud schemes.
• Serve as lead case strategist on all of SIU's complex investigations, coordinating cross-functional response among claims, compliance, underwriting, and legal as well as external investigators or vendors.
• Plan and conduct structured interviews of claimants, agents, witnesses, and other relevant parties, including high-stakes or adversarial interviews requiring advanced interviewing strategy.
• Gather, organize, and critically analyze evidence sets including claim records, policy files, medical records, financial statements, public records, and third-party data sources.
• Compile and organize investigative exhibits, evidence packages, and case files suitable for internal review, civil referral, criminal referral, or regulatory submission.
• Draft clear, concise, and well-supported fraud case summaries and investigative reports for SIU leadership, legal counsel, and compliance teams as well as reports to state departments of insurance and national fraud databases within required timeframes.
• Help define investigative standards, case documentation templates, and onboarding practices.
• Regulatory Compliance: Ensure all SIU activities are conducted in accordance with state and federal insurance fraud regulations.
• Lead preparations and submission of mandatory fraud reports to state departments of insurance and national fraud databases (e.g., NICB).
• Maintain documentation for audits and regulatory reviews.
• Monitor and interpret regulatory changes, emerging fraud schemes, and industry trends, translating implications into updated investigative practice for the team.
• Data & Reporting: Apply advanced data mining and analytics techniques to detect emerging fraud patterns and surface new risk indicators.
• Track and report key case metrics including volumes, investigation outcomes, cycle times, and estimated fraud savings.
• Develop and present fraud trend analyses and reporting for senior leadership.
• Partner with internal and external detection/analytics personnel to refine fraud detection models based on casework findings.
• Training & Awareness: Design and deliver fraud awareness training and educational materials for staff, agents, and distribution partners.
• Monitor industry developments and proactively share insights to strengthen fraud prevention efforts.
• Act as a subject-matter resource for less experienced investigators and other departments on fraud indicators and investigative best practice.

Senior Investigator managing fraud cases in life insurance at Fidelity Life

Senior Special Investigator

Senior Investigator managing fraud investigations related to life insurance claims at Fidelity Life. Leading case strategies and coordinating with internal and external teams for successful outcomes.

• The investigator will generate new investigations, and to continue with ongoing investigation and civil actions involving fraud in areas such as healthcare, contracting, and grants, as well as other fraud and abuse of federal public funds and programs.
• Regularly meets with the ACE attorneys and with designated agency personnel for the purpose of generating fraud investigations.
• Performs a variety of ancillary investigations-related services in direct support of any assigned fraud.
• Utilizes electronic databases such as public records, property records, business records, and other government-maintained databases, to identify documents, witnesses and other physical evidence.
• Prepares reports on progress of investigations for use by AUSAs and supervisory attorneys. These reports may include significant findings and conclusions, analyses of information located in electronic databases, presentations, recommendations for additional investigative actions and candid assessments of strengths and weaknesses of witnesses, documentary evidence, or other aspects of a case.
• Examines books, ledgers, payrolls, cost reports, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation.
• Performs sophisticated analyses of large-scale hard-copy and electronic data, such as health care claims data, financial transaction data, accounting records, or bank records to develop investigative leads and to determine their potential relevance to the allegations at issue.
• Gathers and analyzes facts including witness statements, timelines, and scientific or technical data for the purpose of advancing investigative objectives. Establishes and verifies relationships between facts and evidence obtained or presented to confirm authenticity of documents, to corroborate witness statements, and to otherwise build proof necessary for successful litigation or settlement.
• Develops and analyzes evidence and collects information relating to such evidence, or other legal matters under consideration, from appropriate primary and secondary sources. Performs analysis to clarify the target suspect's or organization's pattern of operations, to identify information relevant to the legal issues involved, and to recommend valuable approaches to the AUSAs or other members of the investigative team. Develops and refines proof required to assist in determining legal responsibility for violations.
• Assists ACE AUSAs with in-person and/or telephonic interviews of witnesses, depositions, and sworn witness examinations.
• Assists with the preparation and service of subpoenas for documentary materials, interrogatory answers, or witness testimony in connection with ACE investigations.
• Develops an understanding of all applicable federal, state, or local laws to the extent necessary to make sound decisions on direction and scope of investigations. Determines proof required to affix responsibility for violations, and devise methods for obtaining, preserving, and presenting evidence to the greatest effect.
• Assists with determining the most efficacious methods for planning, scheduling, and conducting investigations, and identifies any resources that may be required.
• Performs other related ACE investigator duties as assigned and within scope.
• Attends meetings and trainings as may be required and appropriate.

ACE Investigator with fraud detection expertise for federal agency initiative

Civil Enforcement Investigator

ACE Investigator engaged in fraud investigations for a federal agency initiative. Requires extensive knowledge of investigative techniques and teamwork to address government challenges.

Investigator jobs in Illinois

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