Major Case Unit Investigator

Company Overview:

Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you’re ready to grow with the best, explore a career with us and make a difference. We offer a comprehensive benefits package that may include medical, dental, and vision coverage, life insurance, a retirement plan, employee assistance programs, company discounts, and other perks, depending on the position and eligibility.

Job Description:

Allied Universal® is hiring Major Case Unit Investigators

Our operations team has an opening on our MCU Investigator team. This position is responsible for completing insurance fraud investigations and quality control of the final investigative product by providing a high level of technical expertise being delivered to our clients. The position requires the candidate to develop professional relationships with supported customers at the adjuster and management level. The perfect candidate for this role will have an in depth understanding of suspect and non-suspect claims investigations and will be able to communicate effectively to claims staff.

RESPONSIBILITIES:

• Use specialized services to identify new and emerging fraud trends and provide an enhanced focus on complex claims, high-risk claim exposures, such as organized crime-rings, Complex Financial Fraud Schemes, medical provider treatment fraud, medical provider billing fraud, Corporate Investigations, Case File Reviews, Anti-Fraud Consulting, and Criminal Conspiracies involving the insurance industry.
• Conduct complex Investigations across all lines of business in the insurance industry which may involve serious injuries, extensive damages, large scale or multi-party construction defect matters or complicated coverage issues.
• Prioritize assignments, conduct necessary field interviews, and exercise independent judgment, initiative and decision making when developing and following investigative leads.
• Analyze and interpret complex and voluminous evidence and convey highly technical information effectively to others.
• Prepare and submit detailed investigative reports as necessary and make investigative recommendations in accordance with all applicable fraud statutes, case law and the policy contract.
• Assist clients as a subject matter expert/ expert witness, coordinate and attend Examinations Under Oath, and attend legal proceedings as required.
• Educate internal and external business partners (claims operations, internal adjusters, and underwriting staff) on ways to identify potentially fraudulent activity that may require further investigation.
• Utilize the most advanced investigative techniques in the industry to include Analytics; Link Analysis; and Advanced Database and Social Media Analysis to assess suspected fraudulent claims or provider activity and creates business intelligence reports that advance fraud identification and prevention efforts.
• Coordinate with local, state, and federal law enforcement and prosecutors, Department of Insurances, NICB, other carrier SIU’s.

QUALIFICATIONS (MUST HAVE):

• A four-year degree (Criminal Justice preferred) is desired – 4 years of sustained performance as an investigator, police officer, or military investigations may be substituted for 2 years of formal education.
• A minimum of five years of complex criminal investigative experience as a criminal investigator, detective and/or special agent in a full-time capacity, conducting fraud/economic related analysis.
• OR five (5) years of experience as a special investigator conducting insurance claim analysis and investigations with a carrier, third-party administrator and/or vendor contracted special investigations unit, plus one year conducting complex investigations.
• Detailed knowledge of field investigations, including preliminary research, set up, intelligence gathering, lead development, interviewing. And professional report writing.
• Strong computer skills to include Word, Excel, PowerPoint, and Outlook
• Special Investigative Unit (SIU) Compliance knowledge
• Ability to type 40+ words per minute with minimum error
• Ability to learn new software operating systems and platforms.

PREFERRED QUALIFICATIONS (NICE TO HAVE):

• Military Investigations
• Law enforcement Investigations
• One or more of the following professional industry certifications:
• Fraud Claim Law Specialist (FCLS)
• Fraud Claim Law Associate (FCLA)
• Certified Insurance Fraud Investigator (CIFI)
• Certified Fraud Examiner (CFE)
• Certified Financial Crime Investigator (CFCI)

BENEFITS:

• Medical, dental, vision, basic life, AD&D, and disability insurance
• Enrollment in our company’s 401(k)plan, subject to eligibility requirements
• Seven paid holidays annually, sick days available where required by law
• Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law.

Allied Universal® is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com

If you have any questions regarding Equal Employment Opportunity, have difficulty using the online system and require an alternate method to apply, or require an accommodation at any time during the recruitment and/or employment process, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.