Claim Investigator - CSIU

The Auto Club Group is seeking a highly skilled Claim Investigator who would be responsible for reviewing and investigating insurance claims to determine their validity, accuracy, and compliance with company policies and regulatory requirements. They gather and analyze evidence, interview claimants, witnesses and other involved parties, and examine documentation such as police reports and property damage assessments. Their goal is to identify potential fraud, verify claim details, and support fair and timely claim resolutions. Schedule: Monday-Friday 8am-5pm ET. Work environment: hybrid; currently able to work remotely from a home office for day-to-day operations unless occasional travel is specified by leadership.

Responsibilities

Independently perform comprehensive assessment and investigation of personal lines property & casualty claims for the potential of claim fraud; Maintain a thorough understanding of insurance policies, claim handling practices and procedures, and policy eligibility and underwriting requirements; Maintain a comprehensive understanding of claim fraud scenarios and methods; Understand and comply with state laws, regulations, and case law impacting claim fraud and investigation; Contact and collaborate with the assigned claim representative and keep them informed; Review claims to identify potential claim fraud and policy premium fraud scenarios; Complete investigative activities to prove or disprove fraud; Identify insureds, claimants, witnesses, service providers, and other parties and complete interviews or recorded statements; Obtain customer records and documents pertinent to the investigation with permission when necessary; Complete vehicle inspections, home inspections, or site visits; Obtain and follow up on public records and police, fire and other official reports; Complete link analysis; Arrange for and attend Examinations Under Oath; Obtain legal counsel opinion when necessary; Attend court hearings when necessary; Hire and manage experts and vendors for specialized tasks; Balance investigation expense costs against claim facts and exposure; Research and investigate fraud collaborators, fraud rings, and fraudulent service businesses and professionals; Thoroughly document investigative activities, results, and evidence; Work collaboratively with law enforcement, other insurance special investigation units, attorneys, and other parties; Prepare written investigative summaries and report findings to claim handlers, management, underwriters and others; Promote fraud awareness and provide training when assigned

Requirements

College level coursework in Business Administration, Insurance, Criminology or a related field, or equivalent related work experience; Possession of a valid State Driver's License; A valid driver's license is required if the primary responsibilities involve in-person inspections or frequent in-person meetings with members; In states where an Adjuster's license is required, obtain within 90 days; Five years of experience as a claim representative handling Auto or Home personal lines property and casualty insurance claims, OR three years as an investigator in a claims special investigation unit investigating personal lines property & casualty fraud, OR five years in law enforcement in roles such as detective, auto theft investigator, or arson investigator; Knowledge of laws and regulations pertaining to insurance, claim handling, crime, and investigative activity; Knowledge of Auto and Home policy coverages, provisions, eligibility and underwriting rules; Knowledge of claim handling practices; Knowledge of claim fraud scenarios and indicators; Knowledge of fraud investigation techniques and practices; Ability to communicate effectively with others and the public; Ability to analyze policies and claims for relevant provisions; Ability to investigate claims, define appropriate evidence and obtain supportive documentation; Ability to engage and manage experts; Ability to impart fraud awareness training; Ability to function effectively in a personal computer environment using word processing, spreadsheet and software systems; Ability to present effective and persuasive testimony in civil and criminal litigation; Ability to prepare and present effective written reports; Ability to process complex, time-sensitive data from various sources; Ability to complete multiple complex tasks under deadline pressure while working on multiple cases simultaneously; Ability to safely operate a motor vehicle

Nice to have

Bachelor's degree in Business Administration, Insurance, Criminology or a related field, or equivalent related work experience; Completion of The Institutes Associates In Claims (AIC), Chartered Property Casualty Underwriter (CPCU), or other insurance coursework; Fraud Claim Law Specialist Certification; Certified Insurance Fraud Investigator Certification; An active Florida adjuster license; Work experience in both claims handling and fraud investigation; Knowledge of vehicle construction, repair estimation, repair and body shop industry practices; Knowledge of home construction, repair estimation, repair and contractor industry practices

Benefits

Competitive annual salary; Annual company bonus incentive; Medical plans including HSA eligibility; Prescription drug coverage; Dental and vision benefits; Employee Assistance Program; Company-paid basic life insurance; Optional supplemental life and dependent coverage; Short-term and long-term disability coverage; Critical illness, accident, and pet insurance options; 401(k) plan with company match of 50% on employee contributions up to 6% of pay; Additional company contribution of 4% of pay each pay day, 100% vested after three years; HSA and FSA options; Paid Time Off accrual, eligible at 90 days; Up to 12 PTO days annually for full-time new employees; 10 company-paid holidays, 1 mental health day, 2 floating holidays, and 1 volunteer day for full-time employees; Paid parental, bereavement, jury duty, and military leave; Tuition assistance up to $5,250 annually (80% covered); 100% reimbursement for eligible professional certification programs; Career development and advancement opportunities; Complimentary AAA membership with roadside assistance and travel discounts; Adoption assistance program