Combat fraudulent claims practices and other wrong doings, both internally and externally. Assist others in the Claims Department in investigating claims and confirming presence or absence of fraudulent activity. Assist in further developing the knowledge of the company personnel by providing fraud awareness and fraud recognition training.
MAJOR RESPONSIBILITIES AND AUTHORITY
Identify fraudulent claims activity and those responsible for such activity. Perform, in a legal and ethical manner, all functions required for a thorough investigation of potentially fraudulent claims.
Properly collect, document, and store evidence.
Develop leads concerning the investigation; analyze all information.
Coordinate other specialized investigative techniques, including the selection and management of specialized experts.
Assist in preparing case files for litigation, if warranted. Appear and testify in court, as necessary.
Act as a liaison with law enforcement officials for pending criminal matters, if such action is warranted.
Conduct sworn statements and examinations under oath.
Prepare report of findings of investigations.
Assist in preparing SIU case files for litigation as needed.
Establishes and maintains professional relationships with public officials, law enforcement officers, insurance associations, professional associations, and others to obtain assistance in conducting investigation when needed.
Develop programs and presentations for training company personnel, sales agents, and noncompany personnel in areas of fraud.
Complete and forward Claims Department Reports to Underwriting.
Determine the cause and origin of fires associated with claims, if appropriate to individual specialization (CFI).
Communicate the findings of investigations in a detailed, comprehensive report to the Claims Representative, DCM, and SIU Supervisor (or other employees as appropriate) in a timely and expedient manner, using proper methods.
Make suggestions to the Claims Representative and DCM involving investigations of suspicious losses.
The Investigator further investigates the assigned loss and then reports his findings to the Claims Representative, so that a fair and reasonable decision can be made.
Comply with the Certified Fleet Operator requirements of the Company Driving and Safety Policy.
Properly care for and maintain company equipment including car, cell phone, computer, etc.
Other duties as assigned.
MINIMUM POSITION QUALIFICATIONS
Four-year degree from an accredited college or university. Subject to relocation.
Acceptable credit rating.
Overnight travel is required.
Must possess Texas Department of Insurance All Lines Adjuster license and maintain it according to the licensing requirements set forth by the State of Texas; or possess the ability to obtain such license in a reasonable period.
Valid Texas driver license and driving record at the time of hire which would not place the employee on probation, or disqualify the employee from Certified Fleet Operator status, under the Company Driving and Safety Policy.
PHYSICAL REQUIREMENTS
Use of PC, telephone, copy machine, fax, and other office equipment over six (6) hours per day.
Extended periods of sitting and concentration.
Occasional bending, twisting, crouching, pulling, pushing, lifting, reaching and moving items weighing up to 30 lbs.
WORKING CONDITIONS
Investigators must be capable of performing the demanding physical labor associated with digging through the debris of a fire scene.
Occasional long, irregular hours.
Occasional travel by auto or other public transportation.
Work to be conducted in office environment owned or leased by company or the investigator may set up their office at their home of residence given it is a safe and secure environment.
REVISED August 2023
