Claims Fraud Investigator

Claims Fraud Investigator 123957 At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when it comes to choosing your next career move. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location, while facilitating in-person connections and collaborative activities when meaningful and valuable. While the model provides a high level of flexibility and autonomy, occasional circumstances requiring in-office attendance should be expected. The candidate selected for this opportunity should be able to work remotely in one of the following state:Arizona, California, Colorado, Idaho, Iowa, Kansas, Minnesota, Missouri,Montana,Nebraska, Nevada, New Mexico,North Dakota, Ohio, Oregon,South Dakota,Texas, Utah Washington,Wisconsin, and Wyoming. Under general direction and with moderate limits and authority conducts the investigation of suspected fraud and varying degrees of complex cases within an assigned geographic region. Is responsible for delivering high quality and professional investigation reports with decisive conclusions and technically excellent content to ensure that all claims fraud risks are effectively and efficiently governed and managed. This role will have a focus on California investigations and will need to be able to work PST hours as needed. **Additional responsibilities will include:** + Conducts fraud investigations within an assigned geography or Line Of Business in the local Business Unit, or outside normal geography/Line Of Business, as required. + Investigates all aspects of claims referred for investigation, including circumstances of loss, background of individuals/businesses and underwriting aspects + Research information and database searches, prepares surveillance assignment, assigns to vendor and reviews results with subsequent documentation. + Gathers information from various sources and interviews witnesses. + Maintains impeccable documentation, back up and files to support all aspects of the case. + Secures recorded and signed statements. + Evaluates information and evidence in the determination of fraud for assigned cases. + Gathers evidence in a prescribed format which would be required should the matter proceed to arbitration, legal process or criminal prosecution. Prepares and provides investigative reports to Claims, Management, Business Partners, Global Claims or outside agencies including recommendation as to outcome of investigation and whether claim is fraudulent. + Acquire and efficiently organize the relevant evidence and information necessary to accurately assess whether or not there is a fraudulent aspect to individual or fraud network claims. + Liaising closely with senior managers and claim handlers throughout the investigative process and ensuring that all stakeholders are immediately aware of any important issues that are identified. + Identify promptly cases which need to be escalated to the senior staff. + Adheres to local regulation and Zurich Claims governance requirements throughout the investigative process to ensure that all information and data is obtained within data protection rules and regulations. **Basic Qualifications:** + Bachelor's Degree and 4 or more years of experience in the Technical Claims Investigations, Law Enforcement or Insurance Special Investigations areaOR + Zurich Certified Insurance Apprentice, including an Associate Degree and 4 or more years of experience in the Technical Claims Investigations, Law Enforcement or Insurance Special Investigations areaOR + High School Diploma or Equivalent and 6 or more years of experience in the Technical Claims Investigations, Law Enforcement or Insurance Special Investigations area AND + Knowledge of regulations and statutes pertaining to claims law + Knowledge of claims process + Microsoft Office experience **Preferred Qualifications:** + Strong written and verbal communication skills + Strong organization and prioritization skills + Detail oriented. + Previous SIU Field Experience At Zurich, compensation for roles is influenced by a variety of factors, including but not limited to the specific office location, role, skill set, and level of experience. In compliance with local laws, Zurich commits to providing a fair and reasonable compensation range for each role. For more information about our Total Rewards, please click here ( . Additional rewards may encompass short-term incentive bonuses and merit increases. We encourage candidates with salary expectations beyond the provided range to apply as they will be considered based on their experience, skills, and education. The compensation indicated represents a nationwide market range and has not been adjusted for geographic differentials pertaining to the location where the position may be filled. The proposed salary range for this position is $64,600.00 - $95,000.00, with short-term incentive bonus eligibility set at 10%. As an insurance company, Zurich is subject to 18 U.S. Code 1033. A future with Zurich. What can go right when you apply at Zurich? Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please clickhere ( to learn more. Zurich in North America is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission. Location(s): AM - Texas Virtual Office, AM - Arizona Virtual Office, AM - California Virtual Office, AM - Colorado Virtual Office, AM - Idaho Virtual Office, AM - Iowa Virtual Office, AM - Kansas Virtual Office, AM - Minnesota Virtual Office, AM - Missouri Virtual Office, AM - Montana Virtual Office, AM - Nebraska Virtual Office, AM - Nevada Virtual Office, AM - New Mexico Virtual Office, AM - North Dakota Virtual Office, AM - Ohio Virtual Office, AM - Oregon Virtual Office, AM - South Dakota Virtual Office, AM - Washington St Virt. Office, AM - Wisconsin Virtual Office, AM - Wyoming Virtual Office Remote Working: Yes Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-LC1 #LI-ASSOCIATE #LI-HYBRID EOE Disability / Veterans