Allied Universal® Compliance and Investigations, North America’s leading expert insurance claim investigations, compliance and corporate governance company, provides rewarding careers that give you a sense of purpose. While working in a dynamic, diverse and inclusive workplace, you will be part of a team that fuels a culture that will reflect in our communities and customers we serve. We offer medical, dental and vision coverage, life insurance, retirement plan, employee assistance programs, company discounts, perks and more for most full-time compliance and investigation jobs!ARE YOU READY TO INVEST IN YOUR FUTURE?Opportunity is knocking!Join the Allied Universal Compliance and Investigations team today and find out what it means to experience job satisfaction,competitive salary, performance bonuses, career growth, advancement opportunities, a steady schedule and more. You deserve it!Allied Universal® is hiring for full-time Major Case Unit InvestigatorsThis 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.RESP ONSIBILITIES:
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:
A Bachelor’s degree
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.
Must be able to successfully complete the Allied Universal Investigations PI Training/orientation class
Must possess a current and valid driver’s license
Preferred professional designations from one of the following:
Fraud Claim Law Specialist (FCLS)
Fraud Claim Law Associate (FCLA)
Certified Insurance Fraud Investigator (CIFI)
Certified Fraud Examiner (CFE)
Certified Financial Crime Investigator (CFCI)
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.comIf you have any questions regarding Equal Employment Opportunity, Affirmative Action, Diversity and Inclusion, 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 .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.comIf you have any questions regarding Equal Employment Opportunity, Affirmative Action, Diversity and Inclusion, 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 .Location: United States-California-MercedJob Category: Compliance & Investigations