Senior Special Investigator

Overview: 

If you're looking for the stability of a profitable, growing company with the entrepreneurial spirit of a startup, we’re hiring. SageSure, a leader in catastrophe-exposed property insurance, is seeking a Senior Special Investigator. As a Senior Special Investigator, you will take the helm in orchestrating a multi-faceted approach to protect our organization against fraudulent activities. This role is characterized by a strong focus on leadership, compliance, and expertise.

What you’d be doing:

• Lead the development and execution of comprehensive fraud prevention strategies and investigative operations, driving the organization's efforts to maintain its integrity and financial well-being. Review referrals to determine if red flags exist and assigns work to investigators accordingly. Gathers and examines complex data and interprets said data.
• Lead high-profile and sensitive special investigations involving intricate and specialized fraud referrals. These cases often carry significant exposure and complexity, demanding leadership and expertise to ensure their successful resolution.
• Apply advanced knowledge of state laws and regulations relevant to the P&C insurance industry, its products, services, and processes. This knowledge is the cornerstone of the investigative proficiency and a crucial asset to the organization.
• Prepare and deliver detailed, comprehensive, and well-structured verbal and written investigative reports. These reports serve as vital tools in summarizing investigation results and their implications. Review operational output and reports out on patterns related to: Identified fraud, gaps in process, strengths, and weaknesses.
• Serve as a recognized subject matter expert within SIU, offering expert guidance and conducting training for team members involved in fraud investigations. Your knowledge and experience will be instrumental in shaping the expertise of the team. Develop, implement, and deliver training programs tailored to claims and underwriting personnel, enhancing their ability to identify and prevent fraud effectively. Owns and operates control(s) related to an effective and compliant training program.
• Cultivate and sustain external relationships with key stakeholders, industry experts, and law enforcement authorities involved in the complex realm of fraud investigation, detection, and prevention. Your ability to foster these connections is essential for the organization's holistic approach to fraud prevention.
• Take charge of CAT duty responsibilities as necessary, ensuring a rapid and effective response to business requirements during extraordinary events or emergencies.
• Provide invaluable support for regulatory compliance activities. This includes duties such as regulatory reporting, research, training, and educational requirements to ensure the organization remains compliant with industry regulations and standards.
• Harness the capabilities of third-party vendors and specialized tools as a critical component of your approach to conducting effective claim investigations.
• Prepare and deliver professional, concise, and insightful presentations to leadership, providing actionable findings and recommendations on fraud trends, investigation outcomes, and risk mitigation strategies. 

In this senior role, your comprehensive knowledge, leadership, and dedication will be pivotal in fortifying the organization's defenses against fraudulent activities, ensuring its compliance with industry regulations, and maintaining its reputation for integrity and ethical practices. 

We’re looking for someone who has: 

• Bachelor's degree in a related field or equivalent relevant education 10 years’ experience conducting fraud investigations.
• A minimum of 7 years of comprehensive experience in P&C SIU/Fraud investigations or 9 years in a related fraud industry investigation role.
• Demonstrate exceptional expertise and understanding of fraud investigations, including the application of case law, state laws, and regulations.
• Proven track record as a results-driven, seasoned investigator with significant experience in conducting complex statements involving multiple parties.
• Proficiency in gathering a wide range of evidence and arriving at conclusions based on objective details related to fraud applicability.
• A well-documented ability to effectively organize and prioritize workloads, handling multiple tasks and devising solutions for complex problems.
• Proficiency in utilizing computers and various software packages to input and extract data for analysis from pertinent data sources and systems.
• Comprehensive knowledge of city, state, and local regulations, legal principles, contract understanding, case law, medical treatment, and medical terminology.
• Demonstrated expertise in concurrently managing specialty/complex/litigated claims and cases.