Anti-Fraud Special Investigator

Anti-Fraud Special Investigator

Location:

Van Wert, OH;
Dublin, OH Work Model:
Hybrid Position type:
Full time - salary

We're a team of employees passionate about delivering best-in-class customer service and driving innovation in claims management. Integrity, relationships, and excellence are at the heart of everything we do.

Our employees fully utilize their talents and bring their best selves to work. We believe who you are is just as important as what you do!

At Central, our Special Investigative Unit plays an essential role in protecting our policyholders, supporting fair claim outcomes, and preserving the integrity of the insurance process. We combine detailed analysis, field investigation, collaboration, and sound judgment to address complex and potentially fraudulent claims. As an Anti-Fraud Special Investigator, you will partner with claims professionals, regulatory organizations, industry contacts, and law enforcement while sharing your expertise through fraud and technical training.

This is an opportunity to do meaningful investigative work, influence outcomes, and help strengthen fraud awareness across the organization.

• Provides proactive customer service throughout the life of the file by appropriately setting expectations, building rapport, and responding to requests timely of both internal/external customers.
• Identifies and conducts thorough investigations of suspicious claims, review documentation and develop investigative actions
• Conducts field as well as desk investigations of insurance claims referred to the Special Investigative Unit from direct adjuster referral or by various analytic platforms
• Coordinates investigations with outside SIU contacts, the Department of Insurance Fraud Division, NICB, and various law enforcement agencies
• Initiates referrals when a suspicious or fraudulent activity has been identified
• Initiates referrals to State Insurance Department, Fraud bureaus and NICB when a suspicious or fraudulent activity has been identified.
• Develops and presents anti-fraud training programs within claims organization
• Ensures budgets are established and documented in claim file and all invoices reviewed and documented
• Creates monthly reports in a well-written manner, reflecting activity in specific region
• Complies with State Requirements for reporting questionable claims and documented within Case Manager
• Handles work comp files
• Handles bodily injury files
• Conducts claims fraud training and/or technical training
• Conducts own examination under oath (EUO)
• Handles major case overflow files

• Bachelor's Degree in related field and 2 years' experience with a law enforcement agency/SIU group and/or multi-line claims handling experience within the insurance industry
• Or 4 years' experience with a law enforcement agency/SIU group and/or multi-line claims handling experience within the insurance industry
• Possess prior experience in the investigation of insurance fraud
• Travel up to 10-20% for field work

• Successful completion of one or more professional designations: FCLS (Fraud Claims Law Specialist), CIFI (Certified Insurance Fraud Investigator, CFE (Certified Fraud Examiner)

• Solid knowledge of the claims/SIU policies and procedures; exhibits sound interpretation of policies & procedures in investigating and resolving claims
• Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
• Effective verbal and written communication skills
• Must 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
• Ability to conduct detailed investigations and complete all investigative steps
• Ability to understand Central Insurance's policies and processes

Central establishes base pay based on several factors including labor…