Full-Time

SIU Investigator

Confirmed live in the last 24 hours

ICW Group

ICW Group

1,001-5,000 employees

Consulting
Financial Services

Compensation Overview

$68.5k - $115.5kAnnually

+ Bonus

Mid, Senior

Canoga Park, Los Angeles, CA, USA + 3 more

More locations: Pleasanton, CA, USA | Sacramento, CA, USA | San Diego, CA, USA

Hybrid position; requires in-office presence.

Category
Risk & Compliance
Legal & Compliance
Required Skills
Word/Pages/Docs
Data Analysis
Excel/Numbers/Sheets
Requirements
  • Bachelor's degree from four-year college or university preferred with a major or emphasis in Criminal Justice or related field; or equivalent combination of education and experience required.
  • Minimum 4 years of related insurance claim experience required; or equivalent combination of education and experience.
  • Private Investigator's License, fraud related certificates (CFE, CIFI) recommended but not necessary, given proper background experience in fraud investigation.
  • Working knowledge of insurance and claim operations, commercial, personal, and Worker’s Compensation insurance products, and vendor management.
  • Candidates must be proficient in the use of a personal computer, including MS Word, MS Excel, MS Outlook and be able to learn various proprietary computer applications.
Responsibilities
  • Detects and investigates suspected fraudulent claims.
  • Analyzes, organizes, and investigates multi-line types of fraud investigation.
  • Evaluates all referrals for fraud and ensures essential data is located and documented.
  • Ensures investigative results are acted upon and measures ROI of same.
  • Conducts investigations with a focus on thoroughness, quality, with attention to detail, timeliness and cost control.
  • Maintains a systematic and effective method to detect and investigate suspected fraudulent claims and provide for their appropriate disposition.
  • Locates, extracts, analyzes, and organizes critical data from multiple systems to prevent and detect fraud.
  • Ensures the accuracy, quality, and timeliness of the evidence gathered.
  • Understands applicable laws, legal codes, court procedures, precedents, government regulations, executive orders, and agency rules for effective investigations.
  • Prepares and submits timely investigative reports covering all phases of the investigation.
  • Utilizes prescribed case management system (Polonious) to document the detection, investigation and tracking of suspected fraudulent claims, actively moving them towards their appropriate disposition.
  • Manages relationships and keeps consistent communication with multiple departments and outside agencies.
  • Prepares and presents completed investigations to appropriate senior staff and/or criminal justice personnel in a highly professional and timely manner.
  • Maintains contact during the course of investigations with Claim Examiners, Risk Management, Auditors, Hearing Reps, Marketing, Underwriting, Claimants, Policyholders, Agents, Brokers, SIU, Legal and Medical Professionals, Government/Regulatory Agencies, Law Enforcement and Vendors.
  • Facilitates effective communications with regulatory and enforcement agencies.
  • Coordinates vendors to ensure appropriate outcomes and efficient pricing.
  • Helps deter future insurance fraud through training others and keeping abreast on industry research.
  • Assists with the development and training of the claim, underwriting, and integral anti-fraud staff in the detection of external and/or internal fraud.
  • Educates and trains Claim Examiners, Underwriters and integral insurance personnel to identify possible insurance fraud by red flag events.
  • Utilizes multiple online resources to deter and defeat fraud.
Desired Qualifications
  • Associates Degree in Criminal Justice preferred.

Company Stage

N/A

Total Funding

N/A

Headquarters

Round Rock, Texas

Founded

1972

Simplify Jobs

Simplify's Take

What believers are saying

  • Expansion into New York can increase ICW Group's market share in the Northeast.
  • Surety Bonds and Guarantees attract clients in construction and real estate sectors.
  • Change4Change program enhances ICW Group's corporate social responsibility profile.

What critics are saying

  • New York's complex regulatory environment may challenge ICW Group's profitability.
  • Surety Bonds introduce underwriting risks requiring specialized expertise.
  • Charitable initiatives may divert focus from core business operations.

What makes ICW Group unique

  • ICW Group's expansion into New York offers tailored insurance products for regional needs.
  • The addition of Surety Bonds and Guarantees diversifies ICW Group's insurance portfolio.
  • ICW Group's recognition as a Ward's 50 top-performing company enhances its market credibility.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

401(k) Retirement Plan

401(k) Company Match

Performance Bonus

Paid Vacation

Paid Holidays

Professional Development Budget