Claim Investigator (CSIU)

Job Type:

Job Description:

• Independently perform comprehensive assessment and investigation of personal lines property & casualty claims for the potential of claim fraud. 
• Maintain a thorough understanding of insurance policies and claim handling practices and procedures, as well as insurance policy eligibility and underwriting requirements.
•  Maintain a comprehensive understanding of claim fraud, including the fraud scenarios and methods by which insureds, claimants, service providers, and other parties may engage in opportunistic fraud, and also the ways in which businesses, professionals and organized crime groups, such as fraud rings, operate. 
•  Understand and comply with state laws, regulations, and case law impacting claim fraud and investigation activities.
• Contact the claim representative assigned to the claim, work with them collaboratively, and keep them informed throughout the claim investigation. 
• Review claims to identify the potential fraud scenarios that might be present, both for claim fraud and also policy premium fraud. 
• Complete investigative activities that will help prove or disprove the presence of fraud. 
• Investigative activities may include identifying insureds, claimants, witnesses, service providers, and other parties and completing interviews or recorded statements. 
• Obtain customer records such as utility bills and other documents pertinent to the investigation and when necessary, with the permission of the insured. 
• Complete vehicle inspections, home inspections, or conduct site-visits. 
• Obtain and follow-up on public records, as well as police, fire and other official reports.
• Complete link analysis to understand the relationships between people, places, and things. 
• Arrange for and attend Examinations Under Oaths. 
• Obtain legal counsel opinion when necessary. 
• Attend court hearings when necessary. 
• Investigative activities may also involve hiring experts for specialized tasks such as home fire cause and origin analysis, surveillance, vehicle accident reconstruction, forensic accounting, and legal counsel, and managing those vendors through setting clear expectations, monitoring results, and reviewing and paying associated expenses. 
• Complete investigations thoroughly but also balance expense costs against the facts and exposure of the claim.
• Research and investigate fraud collaborators, fraud rings, and potentially fraudulent service businesses and professionals such as medical providers, body shops, attorneys or contractors. 
• Understand and assess the implications of laws, licensing and practices related to those professions and their applicability to identifying and defending against policy and claim fraud.
• Thoroughly document investigative activities, results, and evidence. 
• Work collaboratively with law enforcement, other insurance carrier special investigation units, attorneys, and other parties. 
• Prepare written investigative summaries, and report findings to the assigned claim handler, management, Underwriters and others. 
• Promote fraud awareness and expertise through liaison, consulting, collaboration, and training of company personnel when assigned. 

• College level coursework in Business Administration, Insurance, Criminology or a related field or the equivalent in related work experience. 
• Possession of a valid State Driver's License.
• A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.
• In states where an Adjuster’s license is required, the candidate must obtain within 90 days.

• Five years of experience as a claim representative handling Auto or Home personal lines property and casualty insurance claims.
• Three years as an investigator in a claims special investigation unit that investigates fraud in personal lines property & casualty claims
• Five years in law enforcement in roles such as detective, auto theft investigator, or arson investigator.

• Laws and regulations pertaining to insurance, claim handling, crime, and investigative activity
• Auto and Home policy coverages, provisions, and eligibility and underwriting rules
• Claim handling practices
• Claim fraud scenarios and indicators
• Fraud investigation techniques and practices

• communicate effectively with others in a work environment and with the public (e.g. police department, vendors, contractors, attorneys, other insurance carrier special investigation units)
• analyze policies and claims for relevant provisions and applicability to the claim facts
• investigate claims, define appropriate evidence and obtain supportive documentation
• maintain and continually expend expert knowledge on claim fraud scenarios and indicators
• engage and manage experts to complete specialized tasks
• impart fraud awareness training in a formal or informal setting to other AAA employees, community groups or related professional organizations
• function effectively and independently in a personal computer environment utilizing word processing, spreadsheet and software systems
• present effective and persuasive testimony in civil and criminal litigation on a regular basis
• prepare and present effective written reports (a written sample may be required at time of interview)
• process complex, time sensitive data and information from various sources
• complete multiple complex tasks in a timely fashion and under deadline pressure while working on multiple cases simultaneously
• safely operate a motor vehicle

• Bachelor’s degree in Business Administration, Insurance, Criminology or a related field or the equivalent in related work experience
• Completion of The Institutes Associates In Claims (AIC), Chartered Property Casualty Underwriter (CPCU), or other insurance coursework
• Fraud Claim Law Specialist Certification
• Certified Insurance Fraud Investigator Certification

• Work experience in both claims handling as well as fraud investigation.

• Medical injury treatment and medical provider practices as they relate to automobile accidents
• Vehicle construction, repair estimation, repair and body shop industry practices
• Home construction, repair estimation, repair and contractor industry practices

• Medical plans with multiple coverage options, including HSA eligibility.
• Prescription drug coverage.
• Dental and vision benefits.
• Employee Assistance Program (confidential support services).

• Company-paid basic life insurance.
• Optional supplemental life insurance and dependent coverage.
• Short-term and long-term disability coverage.
• Critical illness, accident, and pet insurance options.

• 401(k) plan to support long-term financial goals.
  • 3% automatic deferral upon eligibility; may contribute 1% to 50% of eligible earnings, either pre or post tax.
  • Company match of 50% paid on employee contributions up to 6% of pay, payable to employees following the end of the year; immediate vesting.
  • Additional company contribution of 4% of pay each pay day into your account; 100% vested after three (3) years of service.

• Health Savings Account (HSA) and Flexible Spending Accounts (FSA) options.

• Paid Time Off (PTO): Accrual-based, increases with tenure, eligible at 90 days of employment.
• Full-time new employees will receive up to 12 PTO days annually; accrual based on start date and may include additional PTO based on role and/or state & local requirements.
• Part-time employee PTO hours are calculated based upon the standard weekly hours the employee is scheduled to work and will accrue at a minimum of 3 hours per month.
• Paid holidays:
  • Full-time employees are eligible for 10 company-paid holidays annually, in addition to 1 mental health day, 2 floating holidays, and 1 volunteer day. Holidays will vary by business schedules
  • Part-time employees are eligible for 8 company-paid holidays annually, in addition to 1 mental health day and 2 floating holidays. Holidays will vary by business unit schedules.
• Paid leave programs, including parental, bereavement, jury duty, and military leave.

• Tuition assistance (up to $5,250 annually; 80% covered by ACG).
• Professional certification support with 100% reimbursement for eligible programs.
• Opportunities for career development and advancement.

• Complimentary AAA membership with roadside assistance and travel discounts.
• Adoption assistance program.

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Who We Are

Become a part of something bigger.

The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.

By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life’s journey through insurance, travel, financial services, and roadside assistance.

And when you join our team, one of the first things you’ll notice is that same, whole-hearted, enthusiastic advocacy for each other.

We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.

To learn more about AAA The Auto Club Group visit www.aaa.com

Important Note:

ACG’s Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.  

The above statements describe the principal and essential functions, but not all functions that may be inherent in the job.  This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements.  Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.

The Auto Club Group, and all its affiliated companies, is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

Regular and reliable attendance is essential for the function of this job.

AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.