Senior Investigator – Special Investigations Unit

🔥 0 minutes ago

🐎 Kentucky, North Carolina, +2 more states – Remote

🐎 Kentucky – Remote 🌲 North Carolina – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote

💵 $68k - $90k / 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 • Collaborate 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 • Apply checklists, referral criteria, and scoring tools to determine whether further investigation is warranted • Conduct moderate- to high-complexity investigations with minimal supervision using field, desktop, or combined methods • Evaluate, coordinate, and recommend investigative action plans with claims, underwriting, and legal partners • Coordinate and monitor outside vendors involved in SIU investigations • Prepare detailed investigative reports and support referrals to law enforcement, legal action, and state fraud bureaus when applicable • Stay informed about regulations, statutes, internal protocols, and procedures • Maintain documentation of investigative actions and work products according to SIU standards and best practices • Serve as a subject matter expert for Claims and Underwriting training on fraud detection, deterrence, and prevention

🎯 Requirements

• 6-8 years of fraud investigation, claims investigation, SIU support, or related research/analyst experience, or equivalent combination of education and experience • Well-developed evidence-gathering and interviewing skills • Ability to follow investigative processes and best practices • Clear written and verbal communication skills • Ability to summarize complex findings • Collaborative mindset and commitment to continuous learning • Proficiency with investigative databases and standard office software • Ability to use computers and software for data entry, digital research tools, and investigative analysis • Ability to document loss scenes and evidence using digital photo/video • Ability to work effectively with AI-enabled investigative tools, including fraud scoring, anomaly detection, entity/link analysis, and automated summarization, while applying sound judgment and documenting decision rationale • Analytical and problem-solving skills • Interpersonal skills • Knowledge of fire cause and origin • Valid driver’s license required • Ability to travel within the assigned 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, prorated based on month of hire • Enhanced PTO may be available for experienced candidates • Bonus eligible based on performance • Opportunities for meaningful work and professional growth • Remote/work-from-home arrangement • Team meetings, training, and corporate events