Major Case Investigator

🔥 0 minutes ago

🏈 Ohio, Massachusetts, +1 more states – Remote

🏈 Ohio – Remote 🍂 Massachusetts – Remote 🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Central Insurance

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1876

🛡️ Insurance

🤝 B2B

👥 B2C

Insurance • B2B • B2C

Central Insurance is a mutual insurance company that provides a broad range of personal and commercial insurance products. Central offers personal lines such as auto, homeowners, renters, flood, umbrella, boat, scheduled personal property, identity fraud and personal cyber protection, and business lines including business owner’s policies, commercial auto, commercial property, crime, cyber suite, employment practices liability, general liability, inland marine, pollution liability, professional liability, and workers’ compensation. The company distributes policies through agents, supports online policyholder account management and claims reporting, publishes annual reports, and operates through at least two underwriting entities: Central Insurance Company and All America Insurance Company.

📋 Description

• Conduct extensive and detailed investigations of high-complexity suspicious losses or organized schemes involving staged accident rings, medical provider treatment and billing rings, and general contractors including public adjusters, roofing, and mitigation companies • Partner with SIU and line-of-business claims personnel to determine whether to initiate organized scheme investigations • Assist in developing training and provide fraud awareness training and technical advice to internal stakeholders • Develop and execute investigation strategies for complex assigned cases, particularly organized or ring-related cases • Gather and evaluate data from multiple internal and external sources to identify and investigate potential fraudulent insurance acts involving Central policies • Lead in-depth interviews of insureds, witnesses, medical professionals, claimants, and other parties associated with claims • Complete detailed investigations in adherence with SIU procedures and best practices • Establish relationships and present cases to Departments of Insurance, NICB, state, local, and federal law enforcement, medical boards, Departments of Professional Licensing, and other necessary departments • Seek potential sources of prosecutorial or administrative action, including the Better Business Bureau, Federal Trade Commission, State Attorney General, and other entities

🎯 Requirements

• Bachelor's degree and 4 years of investigative/Law Enforcement or insurance investigation experience, or 6 years of investigative/Law Enforcement or insurance investigation experience • Ability to travel as assigned • Advanced practical knowledge of conducting clinic inspections and field investigations • Extensive network with law enforcement agencies and ability to collaborate on investigations of suspicious losses • Ability to analyze and interpret complex and voluminous evidence and convey highly technical information effectively • Strong knowledge of CPT codes and fraudulent billing practices, including up coding, unbundling, and inflated practices • Ability to prepare and submit detailed investigative reports and make investigative recommendations • Demonstrated ability to conduct extensive and complex suspicious loss investigations and/or lead organized scheme investigations • Ability to understand Central Insurance's policies and processes

🏖️ Benefits

• Comprehensive total rewards package supporting financial, health, career, and retirement objectives • Extensive health and wellness benefits • Flexibility and work-life balance support • Long-term financial security support