Claim Investigator (Non-Injury) - CSIU

AAA-The Auto Club Group•MI-Admin Office Building (AOB), MI

1d•$67,000 - $87,000•Hybrid

About The Position

The Auto Club Group is seeking a Claim Investigator to review and investigate personal lines property and casualty insurance claims, assess their validity and accuracy, and determine compliance with company policies and regulatory requirements. The role gathers and analyzes evidence, interviews claimants, witnesses, and other involved parties, and examines records and documentation to identify potential fraud, verify claim details, and support fair and timely resolutions. The investigator works collaboratively with assigned claim representatives and other stakeholders, conducting investigations that may include interviews or recorded statements, obtaining records and official reports, inspecting vehicles or homes, visiting sites, performing link analysis, and arranging or attending Examinations Under Oath. The role may engage and manage experts such as fire-cause investigators, surveillance providers, accident reconstruction specialists, forensic accountants, and legal counsel. Investigations must be thoroughly documented and balanced against claim exposure and expenses. The investigator also researches potentially fraudulent collaborators, rings, businesses, and professionals; prepares findings and investigative summaries; and may promote fraud awareness through consultation, collaboration, and training. The position is hybrid, with a Monday–Friday, 8:00 a.m.–5:00 p.m. ET schedule. Day-to-day work may be performed remotely from a home office, subject to occasional travel for meetings or collaborative activities and to changes in the ACG Flex Work policy. The role earns an annual salary of $67,000–$87,000 and may receive an annual company bonus incentive.

Requirements

College-level coursework in Business Administration, Insurance, Criminology, or a related field, or equivalent related work experience.
Valid state driver's license.
Where an adjuster's license is required, obtain it within 90 days.
One of the following experience paths: five years handling Auto or Home personal lines property and casualty claims; three years as an investigator in a claims special investigation unit investigating fraud in personal lines property and casualty claims; or five years in law enforcement in a role such as detective, auto theft investigator, or arson investigator.
Knowledge of at least one of the following: laws and regulations relating to insurance, claim handling, crime, and investigative activity; Auto and Home policy coverage, provisions, eligibility, and underwriting rules; claim handling practices; claim fraud scenarios and indicators; or fraud investigation techniques and practices.
Ability to communicate effectively with colleagues and the public, including police departments, vendors, contractors, attorneys, and other insurance carrier special investigation units.
Ability to analyze policies and claims for relevant provisions and their applicability to claim facts.
Ability to investigate claims, define appropriate evidence, and obtain supporting documentation.
Ability to maintain and continually expand expert knowledge of claim fraud scenarios and indicators.
Ability to engage and manage experts performing specialized tasks.
Ability to deliver fraud-awareness training in formal or informal settings.
Ability to work independently in a personal computer environment using word processing, spreadsheet, and software systems.
Ability to present effective and persuasive testimony regularly in civil and criminal litigation.
Ability to prepare and present effective written reports; a writing sample may be required during the interview.
Ability to process complex, time-sensitive information from various sources and complete multiple complex tasks under deadline pressure while managing multiple cases simultaneously.
Ability to safely operate a motor vehicle.

Nice To Haves

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.
Active Florida adjuster license.
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.

Responsibilities

Assess and investigate personal lines property and casualty claims for potential fraud.
Maintain knowledge of insurance policies, claim handling practices and procedures, policy eligibility, underwriting requirements, fraud methods, and applicable laws and regulations.
Collaborate with assigned claim representatives and keep them informed throughout investigations.
Review claims for potential claim fraud and policy premium fraud scenarios.
Conduct investigative activities to establish or disprove fraud, including identifying and interviewing involved parties and obtaining recorded statements.
Obtain relevant customer records and documents, with the insured’s permission when necessary.
Complete vehicle and home inspections and conduct site visits.
Obtain and follow up on public records, police reports, fire reports, and other official reports.
Perform link analysis to understand relationships among people, places, and things.
Arrange and attend Examinations Under Oath and obtain legal counsel opinions when necessary.
Attend court hearings when necessary.
Hire and manage experts and vendors for specialized investigative tasks, set expectations, monitor results, and review and pay related expenses.
Balance the thoroughness of investigations against expense costs and claim facts and exposure.
Research fraud collaborators, fraud rings, and potentially fraudulent service businesses and professionals.
Assess laws, licensing, and professional practices relevant to identifying and defending against policy and claim fraud.
Thoroughly document investigative activities, results, and evidence.
Work collaboratively with law enforcement, other insurance carrier 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 expertise through liaison, consulting, collaboration, and training when assigned.
Safely operate a motor vehicle and complete work that may involve in-person inspections or meetings.

Benefits

Annual company bonus incentive opportunity.
Medical plans with multiple coverage options, including HSA eligibility.
Prescription drug coverage.
Dental and vision benefits.
Employee Assistance Program.
Company-paid basic life insurance and optional supplemental life and dependent coverage.
Short-term and long-term disability coverage.
Optional critical illness, accident, and pet insurance.
401(k) plan with employer matching and additional company contributions.
Health Savings Account and Flexible Spending Account options.
Accrual-based paid time off for eligible employees.
Company-paid holidays, mental health day, floating holidays, and volunteer day for eligible full-time employees.
Paid parental, bereavement, jury duty, and military leave.
Tuition assistance up to $5,250 annually, with 80% covered by ACG.
Professional certification support with 100% reimbursement for eligible programs.
Career development and advancement opportunities.
Complimentary AAA membership with roadside assistance and travel discounts.
Adoption assistance program.