Anti-Fraud Special Investigator

Central Insurance•Van Wert, OH

4d•Hybrid

About The Position

We’re a team of employees passionate about delivering best-in-class customer service and driving innovation in claims management. Integrity, relationships, and excellence are at the heart of everything we do. Our employees fully utilize their talents and bring their best selves to work. We believe who you are is just as important as what you do! At Central, our Special Investigative Unit plays an essential role in protecting our policyholders, supporting fair claim outcomes, and preserving the integrity of the insurance process. We combine detailed analysis, field investigation, collaboration, and sound judgment to address complex and potentially fraudulent claims. As an Anti-Fraud Special Investigator, you will partner with claims professionals, regulatory organizations, industry contacts, and law enforcement while sharing your expertise through fraud and technical training. This is an opportunity to do meaningful investigative work, influence outcomes, and help strengthen fraud awareness across the organization.

Requirements

Bachelor’s Degree in related field and 2 years’ experience with a law enforcement agency/SIU group and/or multi-line claims handling experience within the insurance industry
Or 4 years’ experience with a law enforcement agency/SIU group and/or multi-line claims handling experience within the insurance industry
Possess prior experience in the investigation of insurance fraud
Travel up to 10-20% for field work
Solid knowledge of the claims/SIU policies and procedures; exhibits sound interpretation of policies & procedures in investigating and resolving claims
Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
Effective verbal and written communication skills
Must perform well in high-energy, dynamic and team-oriented environments
Effective organization and time management skills with the ability to work under pressure and adhere to project deadlines
Excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization
Demonstrate integrity within a professional environment
Ability to adapt to new situations and learn quickly
Ability to conduct detailed investigations and complete all investigative steps
Ability to understand Central Insurance’s policies and processes

Nice To Haves

Successful completion of one or more professional designations: FCLS (Fraud Claims Law Specialist), CIFI (Certified Insurance Fraud Investigator, CFE (Certified Fraud Examiner)

Responsibilities

Provides proactive customer service throughout the life of the file by appropriately setting expectations, building rapport, and responding to requests timely of both internal/external customers.
Identifies and conducts thorough investigations of suspicious claims, review documentation and develop investigative actions
Conducts field as well as desk investigations of insurance claims referred to the Special Investigative Unit from direct adjuster referral or by various analytic platforms
Coordinates investigations with outside SIU contacts, the Department of Insurance Fraud Division, NICB, and various law enforcement agencies
Initiates referrals when a suspicious or fraudulent activity has been identified
Initiates referrals to State Insurance Department, Fraud bureaus and NICB when a suspicious or fraudulent activity has been identified.
Develops and presents anti-fraud training programs within claims organization
Ensures budgets are established and documented in claim file and all invoices reviewed and documented
Creates monthly reports in a well-written manner, reflecting activity in specific region
Complies with State Requirements for reporting questionable claims and documented within Case Manager
Handles work comp files
Handles bodily injury files
Conducts claims fraud training and/or technical training
Conducts own examination under oath (EUO)
Handles major case overflow files