Insurance Fraud Investigator Jobs in Riverside, CA

Who Are We?

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 170 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.

ClaimCompensation Overview

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

Salary Range$94,400.00 - $155,800.001This role is eligible for a sign-on bonus of up to $20,000.
This position is eligible for a hybrid schedule. Employees may work up to 2 days per week at their primary residence.
Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned Specialty Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff.What Will You Do?

• Directly handles assigned severity claims.
• Provides quality customer service and ensures quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
• Consults with Manager on use of Claim Coverage Counsel as needed.
• Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
• Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts.
• Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation.
• Maintains claim files and documents claim file activities in accordance with established procedures.
• Utilizes evaluation documentation tools in accordance with department guidelines.
• Proactively creates Claim File Analysis (CFA) by adhering to quality standards.
• Utilizes diary management system to ensure that all claims are handled timely.
• At required time intervals, evaluate liability & damages exposure.
• Establishes and maintains proper indemnity and expense reserves.
• Recommends appropriate cases for discussion at roundtable.
• Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
• Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others.
• Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance.
• Develops and employ creative resolution strategies.
• Responsible for prompt and proper disposition of all claims within delegated authority.
• Negotiates disposition of claims with insureds and claimants or their legal representatives.
• Recognizes and implements alternate means of resolution.
• Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
• Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy,
• Tracks and controls legal expenses to assure cost-effective resolution.
• Effectively and efficiently manage both allocated and unallocated loss adjustment expenses.
• Perform other duties as assigned.

What Will Our Ideal Candidate Have?

• Bachelor's Degree.
• 5 years equivalent business experience.
• Advanced level knowledge and skill in claim and litigation.
• Basic working level knowledge and skill in various business line products.
• Strong negotiation and customer service skills.
• Skilled in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills.
• Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims.
• Able to make independent decisions on most assigned cases without involvement of supervisor.
• Openness to the ideas and expertise of others actively solicits input and shares ideas.
• Thorough understanding of commercial lines products, policy language, exclusions, ISO forms, and effective claims handling practices.
• Demonstrated coaching, influence and persuasion skills.
• Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.
• Can adapt to and support cultural change.
• Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information.
• Analytical Thinking - Advanced.
• Judgment/Decision Making - Advanced.
• Communication - Advanced.
• Negotiation - Advanced.
• Insurance Contract.
• Knowledge - Advanced.
• Principles of Investigation - Advanced.
• Value Determination - Advanced.
• Settlement Techniques - Advanced.
• Legal Knowledge - Advanced.
• Medical Knowledge - Intermediate.

What is a Must Have?

• High School Degree or GED.
• 3 years of liability claim handling experience and/or comparable litigation claim experience.
• In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements.
• Generally, license(s) are required to be obtained within three months of starting the job.