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Major Case Investigator

Diamond Bar, California

Company Summary

Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.

Target Openings

1

Job Description Summary

Responsible for analyzing data to determine fraud schemes, trends and conducting major case investigations concerning medical and non-medical systemic and organized fraud investigations in all lines of business, including: Auto, Property, General Liability and Workers Compensation. Provides investigative expertise to detect fraud, limit exposure and protect company assets. Focus is directed towards multiple complex case investigations with regional and national implications.

This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.

Primary Job Duties & Responsibilities

  • ESSENTIAL FUNCTIONS
  • Analyzes and summarizes highly technical information related to multiple complex case investigations with regional and national implications.
  • Makes key decisions regarding the structuring and conduction of major case investigations involving multiple claims and/or organized fraud ring activity with regional and national impact.
  • Proactively uses analytical skills to identify potential areas of organized fraud activity or identify areas of vulnerability to fraud to develop investigative plans and/or solutions.
  • (Assists in forecasting needs from emerging trends in the major case and/or organized fraud arena in local area. (e.g., National Insurance Crime Bureau (NICB) and industry alerts, leads from lines of business, etc.).
  • Conducts thorough insurance field investigations while managing resources with a focus on uncovering all potentially fraudulent aspects of claims.
  • onducts technical training for investigative staff to build knowledge base in major case and/or fraud ring identification and investigative techniques.
  • Applies the techniques of critical thinking to prioritizes and develop investigations that have complex allegations and/or significantly financial impact to multiple claims and/or organized ring activity spanning across multiple lines of business and potentially across several states.
  • Applies Local, State and Federal statutes to ensure investigations are carried out within the requirements of applicable law and local office expectations.
  • Provides exceptional customer service by maintaining contact with business partners, customers and external resources throughout the life of each investigation.
  • Acts as a liaison with local/state/federal law enforcement personnel, industry advocates and other companies.
  • Serves as the subject matter expert (liaison) on fraud (medical and non-medical) to business and industry partners.
  • Applies rules of evidence; recognizes evidence and determines its value to specific claim, evidence collection and interpretation.
  • Establishes and maintains liaison network with public officials, law enforcement officers and others to obtain assistance in conducting investigations.
  • Identifies cases for potential insurance fraud prosecution and submits questionable claims to the National Insurance Crime Bureau.
  • Reviews, understands and applies all applicable statutes: local, state and federal to ensure duties and assignments are carried out within the requirements of applicable law and local office expectations.
  • Identifies and addresses investigative priorities through strategic partnerships.
  • Prepares and conducts technical training in detecting and applying techniques to multiple complex cases.
  • Testifies to findings.
  • May conduct missed opportunity reviews of claim files as needed (e.g., by line of business, by emerging trends, etc.).

Minimum Qualifications

  • A minimum of five years of investigative experience; or a minimum of five years insurance claim related experience required.
  • Valid driver's license required.

Job Specific Technical Skills & Competencies

  • PREFERRED JOB SPECIFIC TECHNICAL SKILLS AND COMPETENCIES
  • Analytical skills and ability to make deductions; logical and sequential thinker. - Advanced
  • Analytical and problem solving skills to use and interpret information and facts as well as apply critical techniques to investigative process - Advanced
  • Effective business communication skills (Written & Verbal) - Advanced
  • Computer literate; database, Internet and social media proficient - Advanced
  • Interviewing skills - Advanced
  • Computer literate; database and internet emerging social media use/search proficiency. - Advanced
  • Conflict management skills to deal with crisis situations, hostile witnesses, etc. -Advanced
  • Must be a self-motivated individual - Intermediate
  • Excels at working independently, while making decisions to successfully pursue medical and non-medical insurance fraud through establishing significant facts while preserving material that leads to the resolution of the investigation.
  • - Intermediate
  • Knowledge of available resources (internal and external) to assist in investigations- Advance
  • Working level knowledge of insurance and claim operations, Commercial Lines, Personal Lines, and Workers Compensation insurance products. - Intermediate
  • Time management and accurate record keeping - Intermediate
  • Effective business communication skills (Written & Verbal) - Advanced
  • -Strong case management skills and the ability to manage your own work independently. - Intermediate
  • Adapt to changes in process and shifting priorities - Intermediate
  • Must take ownership/initiative; significant planning and goal setting skills required - Intermediate
  • Presentation and training skills. Intermediate
  • Understanding of claim best practices - Intermediate
  • Leadership, including delegation and ability to get work done through others- Intermediate
  • Influence and conflict management skills - Intermediate

Environmental / Work Schedules / Other

  • Operates standard office equipment: Frequently
  • .
  • Sitting (can stand at will): Continuously.
  • Standing: Occasionally.
  • Lifting items up to 20 pounds: Occasionally.
  • Use of Keyboards, Sporadic 10-Key: Frequently
  • .
  • Driving: Frequently.
  • Travel Requirements: Travel Frequently

Employment Practices

Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. 


If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.


Travelers reserves the right to fill this position at a level above or below the level included in this posting.


About Travelers

The Travelers Companies, Inc. (NYSE: TRV) is a leading property casualty insurer selling primarily through independent agents and brokers. The company's diverse business lines offer its global customers a wide range of coverage in the auto, home and business settings. A component of the Dow Jones Industrial Average, Travelers has more than 30,000 employees and generated revenues of approximately $25 billion in 2010.