Fraud & Investigations Advisor

Guardian Life Insurance•Holmdel Township, NJ

1d•Hybrid

About The Position

Is the opportunity to join a culture where “We Do the Right Thing,” and “We Courageously Shape Our Future Together” important to you? If so, Guardian is seeking a resolute motivated individual to join our team as a Fraud & Investigations Advisor. This role is responsible for investigating potential cases of fraud across a wide array of business units and insurance products. The investigator will provide advice and counsel to business partners and assist with the completion of proactive risk assessments, including supporting the implementation of any necessary action plans or anti-fraud controls. The Investigator will be expected to work in the office at least three days each week and to develop an understanding of anti-money laundering (AML) policies and procedures. You will Conduct investigations from start to finish, including situations involving confidential complex and time-sensitive issues. Perform investigations with due regard to the company's reputation, privacy considerations, business ramifications, financial exposure, and compliance requirements. Plan and develop the theory and scope of each assignment. Consider all civil and criminal options available to Guardian as part of each investigation. Determine priorities and direction of each investigation. Conduct effective interviews with individuals from all socio‐economic levels and draft clear and accurate interview summaries. Analyze and appraise evidence to develop informed objective opinions. Communicate investigative results and evidence in a professional, prompt, impartial, confidential, and accurate manner. Handle a diverse caseload of investigations involving various insurance products, including annuities, dental, disability, life, and supplemental insurance. Communicate with state insurance departments and other regulatory agencies. Utilize outside investigative agencies where necessary and evaluate their effectiveness and performance and make recommendations for future usage. Utilize the Financial Crime Risk Management (FCRM) application to identify potential fraud and abuse, identify and analyze patterns, triage cases, and interpret data. Investigate and resolve transaction monitoring alerts, including the escalation of such alerts when appropriate. Utilize various databases including Thomson Reuters, LexisNexis, and other online sources of information. Negotiate settlements with providers, attorneys, corporate entities, and our insureds. Assist with drafting of settlement agreements. Report fraud or suspected fraud cases to relevant governmental. Attend information‐sharing meetings with peer carriers or organizations such as NHCAA, ACFE, or LIMRA/LOMA. Additional Responsibilities: Assist in high level and complex investigations into potential internal and agent misconduct as directed by senior management. Conduct complex investigations into incidents involving securities, investments and broker-dealer and investment advisory services. Conduct detailed, strategic, and evidence-based and informed interviews of individuals suspected of misconduct or sensitive witnesses. Assist in the completion of confidential fraud case investigations, including the filing of Suspicious Activity Reports (SARs) and Continuing Activity Reports (CARs), when applicable. Assist in completing risk assessments, creating, and presenting fraud training and presentations, and providing advice and counsel about fraud controls to various stakeholders. Assist with special projects such as legislative compliance, public speaking assignments, and others. Create and present fraud awareness training and other presentations to internal stakeholders. Provide subject matter expertise to business partners. Assist in developing fraud controls, fraud monitoring and developing processes and procedures to identify and prevent misconduct. Serve as a liaison to litigation to ensure collaboration with fraud filings and provide investigation services in support of litigation matters.

Requirements

One or more of the following: a Bachelor’s degree in criminal justice; a Bachelor’s Degree and 4 years of insurance investigation experience; 5 years of professional investigation experience with a law enforcement agency; or 7 years of professional investigative experience involving economic or insurance related matters.
Experience conducting investigative, fact-finding interviews.
Ability to identify and extract information from non‐traditional sources.
Strong analytical and problem-solving skills.
A growth mindset with a demonstrated passion for curiosity.
Strong research skills.
Outstanding communication skills (written and verbal).
Self‐Motivated with the ability to multi-task and thrive in a non‐structured environment.
Strong Microsoft Word, Excel, and PowerPoint skills
Ability to incorporate AI tools (e.g., Microsoft Co-Pilot) into day-to-day responsibilities to help drive efficiencies.

Nice To Haves

CFE designation or NHCAA certifications.

Responsibilities

Conduct investigations from start to finish, including situations involving confidential complex and time-sensitive issues.
Perform investigations with due regard to the company's reputation, privacy considerations, business ramifications, financial exposure, and compliance requirements.
Plan and develop the theory and scope of each assignment.
Consider all civil and criminal options available to Guardian as part of each investigation.
Determine priorities and direction of each investigation.
Conduct effective interviews with individuals from all socio‐economic levels and draft clear and accurate interview summaries.
Analyze and appraise evidence to develop informed objective opinions.
Communicate investigative results and evidence in a professional, prompt, impartial, confidential, and accurate manner.
Handle a diverse caseload of investigations involving various insurance products, including annuities, dental, disability, life, and supplemental insurance.
Communicate with state insurance departments and other regulatory agencies.
Utilize outside investigative agencies where necessary and evaluate their effectiveness and performance and make recommendations for future usage.
Utilize the Financial Crime Risk Management (FCRM) application to identify potential fraud and abuse, identify and analyze patterns, triage cases, and interpret data.
Investigate and resolve transaction monitoring alerts, including the escalation of such alerts when appropriate.
Utilize various databases including Thomson Reuters, LexisNexis, and other online sources of information.
Negotiate settlements with providers, attorneys, corporate entities, and our insureds.
Assist with drafting of settlement agreements.
Report fraud or suspected fraud cases to relevant governmental.
Attend information‐sharing meetings with peer carriers or organizations such as NHCAA, ACFE, or LIMRA/LOMA.
Assist in high level and complex investigations into potential internal and agent misconduct as directed by senior management.
Conduct complex investigations into incidents involving securities, investments and broker-dealer and investment advisory services.
Conduct detailed, strategic, and evidence-based and informed interviews of individuals suspected of misconduct or sensitive witnesses.
Assist in the completion of confidential fraud case investigations, including the filing of Suspicious Activity Reports (SARs) and Continuing Activity Reports (CARs), when applicable.
Assist in completing risk assessments, creating, and presenting fraud training and presentations, and providing advice and counsel about fraud controls to various stakeholders.
Assist with special projects such as legislative compliance, public speaking assignments, and others.
Create and present fraud awareness training and other presentations to internal stakeholders.
Provide subject matter expertise to business partners.
Assist in developing fraud controls, fraud monitoring and developing processes and procedures to identify and prevent misconduct.
Serve as a liaison to litigation to ensure collaboration with fraud filings and provide investigation services in support of litigation matters.