Investigator – Special Investigations Unit

West Bend Insurance Company • West Bend, WI

2d • Hybrid

About The Position

Investigate suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines of business. This position offers both remote and hybrid work locations. Candidates who reside within 50 miles of an office location (West Bend, Madison, Appleton) will be offered a hybrid work schedule. Candidates who are fully remote (beyond 50 miles) may occasionally be asked to travel to an office location for in-person engagement activities such as team meetings, training and corporate events.

Requirements

• 6–8 years of fraud investigation, claims investigation, SIU support, or related analyst/research experience (or equivalent combination).
• Strong evidence gathering and interviewing skills with demonstrated adherence to investigative processes and best practices.
• Clear, confident communication - able to summarize complex findings in writing and verbally.
• Strong analytical/problem-solving skills, interpersonal skills, and attention to detail.
• Knowledge of fire cause and origin (preferred).
• Valid driver’s license and ability to travel within an assigned territory.
• Bachelor’s degree in criminal justice, business, data analytics - or equivalent experience.
• Fraud/investigation coursework from NICB, NICTA, IASIU, ACFE, or other recognized organizations.
• Designations such as CIFI, CFE, FCLS, FCLA, and/or general insurance/claims/underwriting designations.

Nice To Haves

• Knowledge of fire cause and origin
• Fraud/investigation coursework from NICB, NICTA, IASIU, ACFE, or other recognized organizations.
• Designations such as CIFI, CFE, FCLS, FCLA, and/or general insurance/claims/underwriting designations.

Responsibilities

• Conduct thorough, compliant, and well-documented investigations using the most effective approach (field, desktop, or a combination) based on what the case requires.
• Identify fraud indicators, gather facts, and document evidence in line with company policy and legal requirements.
• Review claim files for red flags (inconsistencies, late reporting, coverage anomalies, questionable damages, billing concerns) and use checklists/referral criteria/scoring tools to determine next steps.
• Investigate moderate to high complexity cases with minimal supervision, maintaining accuracy, efficiency, and strong investigative judgment.
• Partner closely with Claims, Underwriting, and Legal to recommend and coordinate investigative action plans.
• Coordinate and monitor outside vendor activity connected to SIU investigations.
• Produce clear, detailed investigative reports that support internal decisions and referrals (law enforcement/legal/state fraud bureaus) when needed.
• Stay current on regulations/statutes and maintain audit-ready documentation aligned to SIU best practices.
• Serve as a subject matter expert - supporting training for Claims and/or Underwriting on fraud detection, deterrence, and prevention.

Benefits

• Medical & Prescription Insurance
• Health Savings Account
• Dental Insurance
• Vision Insurance
• Short and Long Term Disability
• Flexible Spending Accounts
• Life and Accidental Death & Disability
• Accident and Critical Illness Insurance
• Employee Assistance Program
• 401(k) Plan with Company Match
• Pet Insurance
• Paid Time Off. Standard first year PTO is 17 days, pro-rated based on month of hire. Enhanced PTO may be available for experienced candidates
• Bonus eligible based on performance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level