Fraud Investigation Specialist

Job Summary

As a full-time remote Fraud Investigation Specialist, the candidate will manage fraud investigations, ensure compliance with state regulations, and collaborate with law enforcement while providing anti-fraud training and quality assurance for the Investigative Services Unit.

Key responsibilities:

• Conduct thorough investigations into potential fraud cases, including desk and field investigations and interviews
• Communicate and collaborate with stakeholders to assess and prioritize referrals for investigation
• Prepare comprehensive investigation reports and document findings in the case management system

Required qualifications:

• Bachelor's degree in business, criminal justice, law enforcement, insurance, or a related field
• Minimum of seven years of experience in law enforcement and/or insurance claims investigations
• Strong knowledge of laws, regulations, and compliance requirements related to insurance
• Demonstrated technical knowledge of insurance administration and claims management
• Ability to analyze and synthesize large data sets and complex policy, financial, and medical records