Senior Investigator – Special Investigations Unit, Illinois, Indiana, Michigan

🔥 14 hours ago

🌽 Illinois, Michigan – Remote

🌽 Illinois – Remote 🚗 Michigan – Remote

💵 $77k - $97k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

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.

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West Bend Insurance Company

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1894

💼 Consulting

🏥 Healthcare

⚖️ Legal

Consulting • Healthcare • Legal

West Bend Insurance Company is a long-established provider of insurance coverages and services, catering to both business owners and individuals. Founded in 1894, the company offers a wide range of insurance solutions, including business insurance, personal auto insurance, homeowners insurance, and workers' compensation. West Bend is committed to customer satisfaction, safety, and community engagement, partnering with organizations to promote environmental sustainability and safety awareness.

📋 Description

• Investigate suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines of business • Work independently and collaboratively with internal stakeholders and external partners to evaluate suspicious insurance transactions • Collect evidence and support fraud detection programs • Communicate investigative findings to internal and external partners, regulators, and law enforcement • Identify red flags, gather facts, and document evidence in compliance with company policy and legal requirements • Review claim files for inconsistencies, late reporting, coverage anomalies, questionable damages, and medical billing issues • Use checklists, referral criteria, and scoring tools to determine whether further investigation is warranted • Conduct and lead thorough investigations of suspect, high-exposure, and complex claims and underwriting/policy concerns • Conduct and lead advanced investigations into organized fraud schemes and develop major cases and potential criminal fraud prosecutions • Evaluate, coordinate, and recommend investigative action plans with claims, underwriting, and legal partners • Coordinate and manage outside vendor activity related to assigned SIU investigations • Prepare detailed investigative reports and support referrals to law enforcement, legal action, and state fraud bureaus • Stay informed on regulations, statutes, internal protocols, and procedures • Maintain documentation according to SIU operating standards and best practices • Serve as a subject matter expert for claims and underwriting training on fraud detection, deterrence, prevention, and complex investigations • Mentor and peer-train the SIU team on investigative strategy and methodology

🎯 Requirements

• 8-10 years of fraud investigation, claims investigation, SIU support, or related research/analyst experience, or equivalent combination of education and experience • Advanced insurance fraud investigative skills, including evidence gathering and interviewing • Ability to follow investigative processes and best practices • Clear written and verbal communication skills, including ability to summarize complex findings • Collaborative mindset and commitment to continuous learning as tools, regulations, and fraud tactics evolve • Proficient in investigative databases and standard office software • Proficient computer and software use for data entry, digital research tools, and investigative analysis • Ability to perform digital photo/video documentation of loss scenes and evidence • Ability to work effectively with AI-enabled investigative tools, such as fraud scoring • Must service the Illinois, Indiana, and Michigan territory

🏖️ 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