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General Special Investigator - Greater Orlando Area

14468

We are Farmers!

We are… more than just your favorite commercials. We are a passionate, award winning, equal opportunity employer, committed to the strength of a diverse workforce. We are dedicated to supporting the well-being of our people through our extensive suite of benefits, as well as the well-being of the communities we serve through employee volunteer programs and nonprofit partnerships. Helping others in their time of need isn’t just our business – it’s our culture! We are Farmers!

 

Do you thrive in a high-volume, fast-paced environment? Do you enjoy the challenge of a position where no two days are alike? We are looking for positive, high-energy professionals who are not just looking for a job, but a meaningful career!

 

Job Summary

This role is responsible for handling complex and high exposure claims and/or identifying fraud. Conducts investigations using proven analytical methods such as statistics and trending, as well as, proven investigative techniques in compliance with all federal, state and local laws pertaining to insurance claim investigations and fair claims-handling practices.

Essential Job Functions

  • Conducts complex claim investigations using advanced investigative techniques in compliance with all federal, state and local laws pertaining to insurance claim investigations and fair claims-handling practices.
  • Investigations may involve interviews and statement taking, use of photographic and sound recording devices, investigative field work, contact with law enforcement, social media and other background checks, as well as other investigative methods and activity of complexity.
  • Coordinates the efforts of outsourced investigative entities and experts in the investigation of unusual and risky claims circumstances, such as fraud rings.
  • Evaluates complex and high exposure claims for potential industry recognized fraud indicators; determines whether SIU involvement in the claim file is necessary in accord with established guidelines; analyzes and documents the claim fraud indicators that warrant SIU involvement, communicates with claim owner, and develops an investigation plan tailored to the needs of the file. Independently follow compliance regulations determine when to report a claim to the NICB, applicable state Department of Insurance and/or other Law Enforcement Agency.
  • Provides articulate explanation and guidance to claims personnel the standard for reporting a claim and the basis for the determination regarding reporting.
  • Uses appropriate judgment in providing underwriting risk advice; takes ownership of the risk advice and ensures all issues discovered are reported and concluded. Supports the development and implementation of fraud strategies.
  • Leads and conducts research, reporting, and analysis on all relevant fraud information and prepares and delivers information to the SIU and Claims leadership teams on a regular basis.
  • Leads and proactively monitors investigation development to determine whether changed circumstances or newly-discovered information warrant a change to investigation plan, including adding additional investigative activity or determining certain investigative activity initially planned for is no longer needed.
  • Documents and supports why the investigative plan changed and outlines the remaining tasks to be completed. Proactively communicates and collaborates with assigned claim owner during the investigative cycle. Completes accurate and professional investigative claim file documentation to include scheduled investigation status updates; reports findings of investigations to key claims stakeholders.
  • Provides professional and expert testimony in legal proceedings when needed.
  • Provides recommendations and execution of the retention of experts, private investigators, and other expenditures. Attends conferences, arbitration hearings as necessary. Is a leader and trainer for industry best practices.
  • Creates and delivers training, formal and informal, to claims and agency force personnel in fraud recognition, investigation and resistance.
  • Establishes and maintains relationships and cooperation with public and private organizations charged with prevention, detection and prosecution of insurance fraud.
  • Provides support and training to all levels of investigators through trend and operational analyses, formal and informal training, and assignments. Assists People Leader with back up/out of office coverage, general employee support and development, and leadership tasks and activities as needed.

Physical Actions

Sits or stands for extended periods of time, up to a full work shift. Occasionally reaches overhead and below the knees, including bending, twisting, pulling, and stooping. Occasionally moves, lifts, carries, and places objects and supplies weighing 0-10 pounds without assistance. Listens to, interprets, and differentiates auditory information (e.g. others speaking) at normal speaking levels with or without correction. Visually verifies and reads information. Visually locates material, resources and other objects. Ability to continuously operate a computer for extended periods of time, up to a full work shift. Physical dexterity sufficient to use hands, arms, and shoulders repetitively to operate keyboard and other office equipment up to a full work shift.

Physical Environment

  • Ideal candidate will be located within the Greater Orlando/Orange County Area, or within 1.5 hours drive time.
  • This will be a remote position, but will require 25% field/travel time. Company car provided. 

Education Requirements

 

  • High school diploma or equivalent required.
  • Bachelors degree preferred. CFE, CIFI, FCLS designations preferred. 

Experience Requirements

  • Minimum 5 years of SIU Claims experience handling.
  • Extensive experience with FL insurance laws, FL Property and FL Medical Claims investigations strongly preferred. 

Job Location(s): US - FL - Orlando

Want to learn more about our culture & opportunities? Check out farmers.com/careers and be sure to follow us on Instagram and LinkedIn!


Nearest Major Market: Orlando

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