Insurance Fraud Investigation Manager Jobs (NOW HIRING)

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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 Tennessee, North Carolina, Kentucky, Virginia 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.

Summary of Responsibilities

Investigate suspected insurance fraud involving auto, property, casualty, workers' compensation, and other personal, commercial, and specialty lines of business. Collaborative with internal stakeholders and external partners to evaluate and investigate suspicious insurance transactions (claims, underwriting, policy, etc.), collect evidence, support fraud detection programs, and communicate investigative findings to internal and external partners, regulators, and law enforcement

Key Responsibilities

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). Apply checklists, referral criteria, and scoring tools to determine whether further investigation is warranted.
• Conduct thorough investigations of suspect insurance claims on moderate to high complexity cases with minimal supervision. Including claims, underwriting/policy concerns, personal, commercial, and specialty lines of business including property, auto, workers compensation, and other coverage types. Meticulous attention to detail to ensure accuracy and thoroughness in investigations and ensure efficient and effective investigations are completed using the most appropriate method of investigation through either field, desktop, or combination thereof.
• Evaluate, coordinate, and recommend investigative action plans in collaboration with claims, underwriting, and legal partners.
• Coordinate and monitor 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, and where applicable to state fraud bureaus.
• Stay informed on regulations and statutes as well as internal protocols and procedures.
• Maintain thorough documentation of investigative actions and work products 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.

Preferred Experience and Skills

• 6-8 years of fraud investigation, claims investigation, SIU support, or related research/analyst experience or equivalent combination of education and experience.
• Well-developed skills in evidence gathering and interviewing with demonstrated ability to follow investigative processes and best practices are essential
• 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 with 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, anomaly detection, entity/link analysis, and automated summarization) while applying sound judgment and documenting the rationale for decisions (human-in-the-loop).
• Analytical and problem-solving Skills
• Interpersonal Skills
• Knowledge of fire cause and origin
• Valid driver's license required; ability to travel within assigned territory

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The salary range for this position is $68,000-$90,000.

The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, business needs, geographical location, and internal equity. Compensation decisions are made by West Bend and are dependent upon the facts and circumstances of each position and candidate.

West Bend offers a comprehensive benefit plan including but not limited to:

• 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

• West Bend will comply with any applicable state and local laws regarding employee leave benefits, including, but not limited to providing time off pursuant to the Colorado Healthy Families and Workplaces Act for Colorado employees, in accordance with its plans and policies.

West Bend provides equal employment opportunities to all associates and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, and promotion.