Claims Fraud Investigator

Zurich Insurance Group•Woodland Hills, CA

5d•Remote

About The Position

Zurich is seeking an experienced Claims Fraud Investigator to join its Claims Fraud and Investigation team. At Zurich North America Claims, we recognize that flexibility and work-life balance are key considerations when choosing your next career move. Our hybrid work model is thoughtfully designed around employee needs offering autonomy to complete focused work from a preferred location, while still supporting meaningful in-person collaboration when it adds value. The ideal candidate for this role will have the opportunity to work fully remote from California. Under general direction and within defined authority limits, this role is responsible for conducting insurance fraud investigations involving complex schemes, multi claim patterns, organized activity, and non-medical major case work. The investigator will perform field activities, coordinate vendor resources, conduct interviews, gather evidence, and deliver clear, objective, and fact-based investigative reports. This role may also support California and travel insurance related investigations as needed. Field travel may be required to conduct interviews, scene examinations, statement collection, evidence gathering, examinations under oath, and support legal proceedings.

Requirements

Bachelor’s Degree and 4 or more years of experience in Technical Claims Investigations, Law Enforcement, or Insurance Special Investigations OR Zurich Certified Insurance Apprentice (Associate Degree) and 4 or more years of relevant experience OR High School Diploma or Equivalent and 6 or more years of experience in Technical Claims Investigations, Law Enforcement, or Insurance Special Investigations
Knowledge of claims processes and relevant fraud related regulations
Proficiency in Microsoft Office

Nice To Haves

Prior law enforcement investigation experience
5 or more years investigating insurance fraud
SIU experience preferred
Experience investigation commercial claims
Experience with both single non-complex investigations and complex investigations, including multi claim linkages, contractor or vendor fraud, or organized fraud networks

Responsibilities

Conduct investigations into suspected insurance fraud within assigned territories or Lines of Business, including complex, layered, or organized schemes.
Evaluate all aspects of referred claims, including loss circumstances, backgrounds of involved parties, documentation validation, and underwriting considerations.
Perform database research, open-source intelligence reviews, social media assessments, and link analysis to identify inconsistencies or coordinated fraud indicators.
Assign and oversee vendor activities such as surveillance, scene investigations, and specialized investigative tasks; review deliverables and ensure proper documentation.
Conduct recorded interviews, site visits, canvases, and other investigative steps to verify material facts and identify fraud indicators.
Maintain highly organized case files and documentation that accurately reflect investigative actions and findings.
Analyze evidence to determine potential misrepresentation, fraud, or network linked activity involving multiple claims.
Prepare clear, comprehensive investigative reports with objective findings and recommendations for claims teams and management.
Communicate critical investigative developments promptly and collaborate closely with claims partners throughout the investigative process.
Identify cases that warrant escalation due to suspected organized fraud rings, staged events, or potential law enforcement involvement.
Ensure all investigative activity complies with SIU regulatory requirements, privacy laws, and Zurich governance standards.
Travel as necessary to conduct interviews, inspections, and field investigations.