Job Description

Locations

• TUCSON, Arizona, United States

Salary

Skills Required

• strong investigative skillsintermediate
• Proficiency in claims management software, Microsoft Office Suite, and investigative toolsintermediate
• Strong analytical and critical thinking skillsintermediate
• Excellent written and verbal communication skillsintermediate

Required Qualifications

• Bachelor’s Degree in Criminal Justice, related field, or equivalent experience (experience)
• Minimum of 1 year of experience in insurance claims handling, fraud investigation, or a related field (experience, 1 years)
• Strong analytical and critical thinking skills to evaluate complex data and identify fraud indicators (experience)
• Excellent written and verbal communication skills for report writing and stakeholder interaction (experience)
• Proficiency in claims management software, Microsoft Office Suite, and investigative tools (experience)

Preferred Qualifications

• Prior experience in an SIU or desk-based investigative role is preferred (experience)
• Certified Fraud Examiner (CFE), Certified Insurance Fraud Investigator (CIFI), or similar credentials are a plus (certification)

Responsibilities

• Review and analyze insurance claims to identify red flags, inconsistencies, or patterns indicative of potential fraud
• Conduct desk-based investigations, including gathering and reviewing documentation, policy details, and claimant information to support fraud detection
• Utilize internal databases, public records, and third-party tools to verify information and uncover discrepancies in claims
• Work closely with field investigators, claims adjusters, legal counsel, and law enforcement to build comprehensive case files and support fraud investigations
• Prepare detailed reports, summaries, and recommendations based on investigative findings for management and legal teams
• Ensure all investigations adhere to company policies, state regulations, and industry standards regarding privacy and ethics
• Maintain clear and professional communication with claimants, witnesses, and other parties while protecting sensitive information

Benefits

• general: Aetna PPO and HSA plans > 2 medical plan options with $0 payroll deduction
• general: Family-building, fertility, adoption and surrogacy benefits
• general: Dental (including orthodontic coverage) and vision plans, both have options with a $0 paycheck contribution
• general: Company Paid (Health Savings Account) HSA Contribution when enrolled in the High Deductible Aetna medical plan with HSA
• general: Healthcare and Dependent Care Flexible Spending Accounts (FSA)
• general: 401(k) with employer match, Employee Stock Purchase Plans, and other financial benefits
• general: Company paid Basic Life, AD&D, short-term and long-term disability insurance
• general: Employee Assistance Program
• general: Sick and Vacation time (Flex time for salary positions), and Paid Holidays
• general: Back-up childcare and parenting support resources
• general: Voluntary benefits to include: critical illness, hospital indemnity, accident insurance, theft & legal services, and pet insurance
• general: Weight Loss and Tobacco Cessation Programs
• general: Tesla Babies program
• general: Commuter benefits
• general: Employee discounts and perks program

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