Anti-Fraud Investigator Jobs

Location: Hybrid Work Model – Alpharetta, Georgia
We are a team of employees who are passionate to deliver best in-class customer service and innovation in the industry. It’s because we put Integrity, Relationships and Excellence in all aspects of our work.
Our employees have the opportunity to fully utilize their talents and bring their best self. We believe that who you are is just as important as what you do!
As an Anti-Fraud Investigator, you will be responsible for identifying and conducting thorough investigations of suspicious claims, review documentation and develop investigative actions. You will conduct field as well as desk investigations of insurance claims referred to the Special Investigative Unit from direct adjuster referral or by various analytic platforms.
How You’ll make an Impact

• Ensures budgets are established and documented in claim file and all invoices reviewed and documented
• Handles bodily injury files
• Identifies and conducts thorough investigations of suspicious claims, review documentation and develop investigative actions
• Handles major case overflow files
• Coordinates investigations with outside SIU contacts, the Department of Insurance Fraud Division, NICB, and various law enforcement agencies
• 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.
• Handles work comp files
• Develops and presents anti-fraud training programs within claims organization
• Conducts own examination under oath (EUO)
• Conducts claims fraud training and/or technical training
• Initiates referrals when a suspicious or fraudulent activity has been identified
• Complies with State Requirements for reporting questionable claims and documented within Case Manager
• Initiates referrals to State Insurance Department, Fraud bureaus and NICB when a suspicious or fraudulent activity has been identified.
• 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
• Creates monthly reports in a well-written manner, reflecting activity in specific region

What You’ll Bring

• Excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization
• Solid knowledge of the claims/SIU policies and procedures; exhibits sound interpretation of policies & procedures in investigating and resolving claims
• Preferred:
• Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
• Effective verbal and written communication skills
• Ability to conduct detailed investigations and complete all investigative steps.
• Effective organization and time management skills with the ability to work under pressure and adhere to project deadlines
• Ability to adapt to new situations and learn quickly
• Must perform well in high-energy, dynamic and team-oriented environments
• Demonstrate integrity within a professional environment
• 5+ years of 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
• Successful completion of one or more professional designations: FCLS (Fraud Claims Law Specialist), CIFI (Certified Insurance Fraud Investigator, CFE (Certified Fraud Examiner)
• Travel up to 10-20% for field work
• Bachelor’s Degree or in-lieu of degree equivalent education, training and work-related experience

It is the policy of Central that all recruiting, hiring, training, compensation, overtime, job classification and assignment, facilities, promotions, transfers, employee treatment and all other terms and conditions of employment shall be maintained in a manner which will not discriminate against any person because of race, color, age, sex, national origin, ancestry, religion, marital status, military status, or disability. The applicant should respond to questions on this application in a way that will not divulge such information. #LI-Hybrid