[Hiring] Senior Investigator – Special Investigations Unit @West Bend Insurance Company

Role Description

Investigate suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines of business.

This is a fully remote/work from home role where you will spend at least 50% of your time in the field, servicing the Illinois, Indiana, and Michigan territory. On occasion you may be asked to travel to an office location for in-person engagement activities such as team meetings, training and corporate events.

Qualifications

• 8-10 years of fraud investigation, claims investigation, SIU support, or related research/analyst experience or equivalent combination of education and experience.
• Advanced insurance fraud investigative skills including evidence gathering and interviewing with demonstrated ability to follow investigative processes and best practices.
• Clear written and verbal communication skills, including the ability to summarize complex findings.
• Collaborative mindset and commitment to continuous learning as tools, regulations, and fraud tactics evolve.
• Proficient in investigative databases and standard office software.
• Ability to proficiently use computers and software for data entry, digital tools for research, and investigative analysis; digital photo/video documentation of loss scenes and evidence.
• Ability to work effectively with AI-enabled investigative tools (e.g., fraud scoring).

Requirements

• Support fraud detection and investigation by identifying red flags, gathering facts, and documenting evidence in compliance with company policy and legal requirements.
• Review claim files for basic red flags (inconsistencies, late reporting, coverage anomalies, questionable damages, medical billing issues).
• Conduct and lead thorough investigations of suspect, high exposure, and complex insurance claims and underwriting/policy concerns.
• Meticulous attention to detail to ensure accuracy and thoroughness in investigations.
• Conduct and lead advanced comprehensive investigations into organized fraud schemes.
• Evaluate, coordinate, and recommend investigative action plans in collaboration with claims, underwriting, and legal partners.
• Coordinate and manage outside vendor activity related to assigned SIU investigations.
• Prepare detailed investigative reports for internal decision-making; support referrals to law enforcement or legal action when necessary.
• Stay informed on regulations and statutes as well as internal protocols and procedures.
• Maintain thorough documentation of investigative actions and work product in accordance with accepted SIU operating standards and best practices.
• Serve as a subject matter expert for claims and/or Underwriting Department training on the detection, deterrence, and prevention of fraud.
• Serve as mentor and peer trainer for the SIU team, consulting on investigative strategy and methodology.

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, pro-rated based on month of hire.
• Enhanced PTO may be available for experienced candidates.
• Bonus eligible based on performance.