Farmers Insurance Bristol West - Sr. Special Investigator in Brea, California
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Develops and conducts special investigations of claims, including major or more complex losses, to confirm claim validity or to identify fraud. Determines whether to refer a claim to the applicable department of insurance, the National Insurance Crime Bureau (“NICB”), and/or law enforcement. Provides underwriting risk advice. Assists, consults with, and advises Field Claims employees and the Agency Force in recognizing and resisting fraudulent claims. Prepares and conducts fraud awareness/resistance training. Establishes and maintains liaison and cooperation with public and private organizations charged with prevention, detection and prosecution of insurance fraud. Coordinates and directs the efforts of contracted private investigators. Makes recommendations regarding the retention of experts, private investigators, and other expenditures. May assist Team Leaders and/or Management Personnel with additional administrative tasks.The ideal candidate will reside in West LA and have experience as a field adjuster/appraiser.
Essential Job Functions
Determines whether SIU involvement in the claim file is necessary, in accord with established guidelines, and will add value to the claim process. If SIU involvement is not appropriate, recommends to the SIM that the file be removed from the Tracker system. Evaluates the entire claim, not only the unit being referred, for potential fraud indicators. Determines, analyzes, and describes the claim fraud indicators that warrant SIU involvement, and communicates them to the applicable claims professional assigned. Uses his/her judgment to determine how to conduct the investigation in a manner appropriate to the issues presented, outlines the investigative tasks that he/she will conduct to resolve the issues, and explains why he/she decided to conduct those tasks. Develops and conducts investigations into large or complex losses as well as other investigations. Coordinates the efforts of internal and outside resources in the investigation of complex and unusual claims situations, such as fraud rings. Responsible for using sound investigative techniques in compliance with all federal, state and local laws pertaining to investigations and fair claims-handling practices. Investigations may involve vehicle or public carrier travel, field interviews, use of photographic and sound recording devices. As the investigation develops, determines whether changed circumstances or newly discovered information warrant a change to the investigation plan, including adding additional tasks or deciding that certain tasks need not be performed. Explains why he/she changed the investigative plan and described the remaining tasks to be completed. Determines whether to refer a claim to the applicable department of insurance, the NICB, and/or law enforcement and advises the claims representative accordingly. Describes to the claims representative the standard for referring a claim and the basis for the determination regarding referral. Uses appropriate judgment in providing underwriting risk advice. Takes ownership of the risk advice and ensures that any issues are reported as needed. Recommends retention of experts or private investigators, surveillance, or other expenditures. Provides support and training to other Special Investigations Unit personnel through, among other things, trend and operational analyses, formal training classes, informal training, case assignments, relief supervision of investigators. Provides formal and informal training and counseling to Claims personnel, District Managers and Agents in fraud recognition, investi gation and resistance. And must be available to consult with and advise claims representatives and other Claims personnel upon request. Attends industry recognized intelligence meetings Case preparation for Law Enforcement
High school diploma or equivalent required. Bachelor’s degree preferred.
Minimum of 2 years experience in field SIU Decision making and problem solving skills, both written and verbal communication skills and ability to work independently
Special Skill Requirement
Knowledge of claims operations Pursuing FCLS
Farmers is an equal opportunity employer, committed to the strength of a diverse workforce.
Organization: *Farmers Insurance
Title: Bristol West - Sr. Special Investigator
Requisition ID: 2000003B