Anti-Fraud Investigator

Waltham, MA 02451, USA Req #184
Monday, January 18, 2021

As an Anti-Fraud Investigator, you will be responsible for identifying and conducting thorough investigations of suspicious claims, review documentation, and develop investigative actions.  You will conduct field as well as desk investigations of insurance claims referred to the Special Investigative Unit from direct adjuster referral or by various analytic platforms.
 

What will you do?

  • Coordinate investigations with outside SIU contacts, the Department of Insurance Fraud Division, NICB, and various law enforcement agencies Initiate referrals when a suspicious or fraudulent activity has been identified
  • Initiate referrals to State Insurance Department, Fraud bureaus and NICB when a suspicious or fraudulent activity has been identified.
  • Develop and present anti-fraud training programs within claims organization
  • Travel up to 30% for field work

What experience will you bring?

  • 5+ years of experience with a law enforcement agency, SIU group, and/or multi-line claims handling experience within the insurance industry
  • Prior experience in the investigation of insurance fraud
  • Proven solid knowledge of the claims/SIU policies and procedures exhibiting sound interpretation with investigating and resolving claims
  • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
  • Effective verbal and written communication skills
  • 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
  • Bachelor’s Degree or equivalent education, training, and work-related experience
  • Successful completion of one or more professional designations:
    • FCLS (Fraud Claims Law Specialist), CIFI (Certified Insurance Fraud Investigator), CFE (Certified Fraud Examiner) 

The values that Central lives by are Integrity, Relationships, and Excellence. Do you…

  • Take responsibility for actions and outcomes
  • Treat others with respect
  • Care, because it matters
  • Listen and respond
  • Never compromise on quality
  • Commit to learning and development

It is the policy of Central that all recruiting, hiring, training, compensation, overtime, job classification and assignment, facilities, promotions, transfers, employee treatment and all other terms and conditions of employment shall be maintained in a manner which will not discriminate against any person because of race, color, age, sex, national origin, ancestry, religion, marital status, military status, or disability.  The applicant should respond to questions on this application in a way that will not divulge such information.

  • Waltham, MA 02451, USA