Senior Investigator

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $78.7k - $132.7k / year

⏰ Full Time

🟠 Senior

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ICW Group

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🤝 B2B

🌍 Social Impact

Insurance • B2B • Social Impact

ICW Group is a comprehensive insurance provider specializing in workers' compensation, catastrophe, and assumed reinsurance. They offer a wide array of services including claims reporting, risk management, and preventive safety measures to protect businesses and their employees. ICW Group is committed to providing excellent customer service and enhancing workplace safety. Additionally, they are involved in philanthropy, particularly focusing on improving the lives of children in the communities they serve. The company also facilitates various resources for agents and policyholders to seamlessly manage insurance requirements and claims processes.

📋 Description

• Leads Complex and Major Case Investigations • Conducts advanced, large-scale investigations involving organized fraud rings, provider fraud schemes, (medical, legal, and ancillary services), referral/kickback schemes • Identifies patterns of coordinated activity across multiple claims to detect systemic and enterprise-level fraud risks • Independently manages complex, multi-jurisdictional cases from inception to resolution • Interviews claimants, witnesses, employers, medical providers, and legal representatives, utilizing advanced interviewing and interrogation techniques • Develops and secures recorded statements, affidavits, and evidence to support investigative findings • Performs on-site investigations, clinic inspections, and surveillance coordination as appropriate • Interprets and synthesizes large volumes of data from multiple sources, including claims systems, billing records, social media, and third-party databases • Identifies anomalies, trends, and networks/relationships indicative of fraud through link analysis and data correlation • Develops actionable intelligence packages to support internal stakeholders and external enforcement actions • Evaluates referrals for fraud indicators and determines appropriate investigative strategies • Builds comprehensive case files supported by well-documented evidence, timelines, and investigative summaries • Ensures all findings meet standards required for regulatory reporting, civil litigation, and criminal prosecution • Partners closely with law enforcement, district attorneys, regulatory agencies, and legal counsel to advance cases • Presents investigative findings in a professional manner for case review, prosecution, or civil recovery actions • Maintains detailed knowledge of relevant laws, regulations, and evidentiary standards • Produces clear, concise, and defensible investigative reports covering all aspects of the case lifecycle • Maintains accurate documentation in case management systems and ensures timely progression of cases.

🎯 Requirements

• Bachelor’s degree with a major in Criminal Justice, Business, Accounting, Information Systems, or closely related (or an equivalent combination of education/experience) • Minimum of 5 years’ related work experience required • Senior SIU Field Investigator requires experience specifically in investigations and/or law enforcement • Private Investigator's License or fraud related certificates (CFE, CIFI) preferred • Requires valid Driver’s license. • Good computer skills in Microsoft Office/Outlook and expertise using investigative case management software/tools (such as Polonious or similar) • Experience with case management systems and investigative tools • Fundamental knowledge of claims management processes and claims handling • Knowledge of Unfair Claims Practices Act, Legislative, and Insurance Department regulatory requirements • Familiarity with civil/criminal investigation procedures and the legal system • Demonstrated experience with managing relationships to complete thorough investigations • High level of critical thinking, attention to detail, and independent judgment • Excellent written/verbal and presentation skills • Experience with advanced investigative and interviewing skills • Ability to analyze and interpret large, complex data sets • Strong knowledge of fraud schemes, claims handling, legal procedures, and medical/services billing • Ability to present information within a courtroom setting.

🏖️ Benefits

• Health insurance • 401K retirement plans and company match • Paid Time Off • Paid holidays throughout the calendar year • Professional development support