Special Investigator II

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 Special Investigator II. As a Special Investigator 2, you will play a significant role in our efforts to combat fraudulent activities, supporting our organization's commitment to integrity and financial well-being. The role is marked by a strong focus on investigative expertise and compliance

What you’d be doing

• 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.

We’re looking for someone who has

• 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.