Insurance Fraud Examiner Jobs (NOW HIRING)

Company Details

"Our Company provides a state of predictability which allows brokers and agents to act with confidence."Founded in 1967, W. R. Berkley Corporation has grown from a small investment management firm into one of the largest commercial lines property and casualty insurers in the United States.Along the way, we've been listed on the New York Stock Exchange, become a Fortune 500 Company, joined the S&P 500, and seen our gross written premiums exceed $10 billion.Today the Berkley brand comprises more than 50 businesses worldwide and is divided into two segments:  Insurance and Reinsurance and Monoline Excess.  

The Company is an equal employment opportunity employer.

Responsibilities

The SIU Manager is responsible for assisting with leading our anti-fraud efforts to include both commercial and personal lines of business. This role is critical in safeguarding the integrity of our claims process, mitigating financial losses, and ensuring compliance with regulatory mandates.

The SIU Manager will be responsible for overseeing a team of investigators and support specialists, managing complex and high-exposure investigations, and assisting with investigative tools to support the enterprise anti-fraud efforts. This position requires a deep understanding of commercial and personal insurance operations, investigative techniques, and regulatory frameworks.

Key Functions/Duties of Position:

Leadership & Strategy

• Lead, mentor, and manage a team of SIU investigators and support specialists, ensuring high performance, professional development, and adherence to best practices.
• Execute a strategic vision for fraud detection and prevention across all lines of business.
• Establish and monitor key performance indicators (KPIs) to measure the effectiveness of the SIU program.
• Collaborate with senior leadership to align SIU goals with broader organizational objectives.

Investigative Oversight

• Oversee the intake, triage, and assignment of suspected fraudulent claims, ensuring timely and thorough investigations.
• Direct the investigation of complex, high-value, or sensitive cases involving potential fraud, collusion, staged losses, or organized crime.
• Ensure investigative activities are conducted in accordance with legal standards, company policies, and industry best practices.
• Review and approve investigative reports, summaries, and referrals to law enforcement or regulatory bodies.

Quality Assurance & Compliance

• Manage and implement a comprehensive quality assurance program to evaluate the accuracy, completeness, and compliance of SIU investigations.
• Conduct regular audits of investigative files to ensure adherence to internal protocols, regulatory requirements, and industry standards.
• Provide feedback and coaching to investigators based on audit findings to drive continuous improvement.
• Monitor trends in investigative performance and develop targeted training or process enhancements as needed.
• Ensure timely and accurate reporting to state fraud bureaus, the NICB, and other regulatory entities.

Compliance & Reporting

• Ensure compliance with all applicable state and federal regulations, including mandatory fraud reporting requirements.
• Maintain accurate and timely documentation of all investigative activities in the case management system.
• Prepare and submit regulatory reports, internal dashboards, and executive summaries as required to SIU Leadership.
• Serve as a primary liaison with state fraud bureaus, the National Insurance Crime Bureau (NICB), and other external agencies.

Collaboration & Training

• Partner with claims, underwriting, legal, and risk management teams to identify fraud trends and vulnerabilities.
• Provide training and guidance to claims staff on fraud indicators, red flags, and referral procedures.
• Represent the company at industry conferences, fraud task forces, and professional associations.

Technology & Innovation

• Leverage data analytics, predictive modeling, and fraud detection software to enhance investigative capabilities.
• Evaluate and implement new tools and technologies to improve SIU efficiency and effectiveness.

Qualifications

Qualifications:

Minimum of 7-10 years of experience in insurance fraud investigations, with minimum of 3 years in a supervisory or managerial role. Extensive knowledge of commercial and personal insurance products and claims processes. Completion of one or more of the following designations: Fraud Claims Law Specialist (FCLS), Certified Insurance Fraud Investigator (CIFI), Certified Fraud Examiner (CFE), Chartered Property Casualty Underwriter (CPCU), Associate in Claims (AIC).

Education Requirement

Bachelor's degree in Criminal Justice, Insurance, Business Administration, or a related field.

Additional RequirementsLocation and Travel: Primary location Urbandale, IA. Additional locations: High Point, NC; Irving, TX; Florida; Atlanta, GA; Glen Allen, VA; Chesterfield, MO; Scottsdale, AZ; Pennsylvania. Travel: Occasional travel is required (up to 20%).Sponsorship DetailsSponsorship not Offered for this RoleEmployment Type: OTHER