About the role
Company Overview
Recognized as a Milwaukee Journal Sentinel Top Workplace for 14 consecutive years, including three years of being honored as number one! Join us at West Bend, where we believe that our associates are our greatest asset. We hire talented individuals who are conscientious, dedicated, customer focused, and able to build lasting relationships. We create and maintain an environment where you feel a sense of belonging and appreciation. Your diversity of thought, experience, and knowledge are valued. We’re committed to fostering a welcoming culture, offering you opportunities for meaningful work and professional growth. More than a workplace, we celebrate our successes and take pride in serving our communities.
Job Summary
Investigate suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines of business.
Work Location
This is a fully remote/work from home role where you will spend at least 50% of your time in the field, servicing the Illinois, Indiana, and Michigan territory. On occasion you may be asked to travel to an office location for in-person engagement activities such as team meetings, training and corporate events.
Responsibilities & Qualifications
Summary of Responsibilities
Investigate suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines of business. Work independently and collaboratively with internal stakeholders and external partners to evaluate and investigate suspicious insurance transactions (claims, underwriting, policy, etc.), collect evidence, support fraud detection programs, and communicate investigative findings to internal and external partners, regulators, and law enforcement.
Key Responsibilities
Support fraud detection and investigation by identifying red flags, gathering facts, and documenting evidence in compliance with company policy and legal requirements.
Review claim files for basic red flags (inconsistencies, late reporting, coverage anomalies, questionable damages, medical billing issues). Apply checklists, referral criteria, and scoring tools to determine whether further investigation is warranted.
Conduct and lead thorough investigations of suspect, high exposure, and complex insurance claims and underwriting/policy concerns, including personal, commercial, and specialty lines of business – including property, auto, workers compensation, and other coverage types.
Meticulous attention to detail to ensure accuracy and thoroughness in investigations and ensure efficient and effective investigations are completed using the most appropriate method of investigation through either field, desktop, or combination thereof.
Conduct and lead advanced comprehensive investigations into organized fraud schemes, developing major cases and potential criminal fraud prosecutions working with internal and external legal, fraud bureaus, and law enforcement agencies.
Evaluate, coordinate, and recommend investigative action plans in collaboration with claims, underwriting, and legal partners.
Coordinate and manage outside vendor activity related to assigned SIU investigations.
Prepare detailed investigative reports for internal decision-making; support referrals to law enforcement or legal action when necessary, and where applicable to state fraud bureaus.
Stay informed on regulations and statutes as well as internal protocols and procedures.
Maintain thorough documentation of investigative actions and work product in accordance with accepted SIU operating standards and best practices.
Serve as a subject matter expert for claims and/or Underwriting Department training on the detection, deterrence, and prevention of fraud, as well as high exposure and complex investigations.
Serve as mentor and peer trainer for the SIU team, consulting on investigative strategy and methodology.
Preferred Experience and Skills
8-10 years of fraud investigation, claims investigation, SIU support, or related research/analyst experience or equivalent combination of education and experience.
Advanced insurance fraud investigative skills including evidence gathering and interviewing with demonstrated ability to follow investigative processes and best practices are essential
Clear written and verbal communication skills, including the ability to summarize complex findings; collaborative mindset and commitment to continuous learning as tools, regulations, and fraud tactics evolve.
Proficient in investigative databases and standard office software.
Ability to proficiently use computers and software for data entry, digital tools for research, and investigative analysis; digital photo/video documentation of loss scenes and evidence.
Ability to work effectively with AI-enabled investigative tools (e.g., fraud scoring)
Salary Statement
The salary range for this position is $77,000-$97,000.
The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, business needs, geographical location, and internal equity. Compensation decisions are made by West Bend and are dependent upon the facts and circumstances of each position and candidate.
Benefits
West Bend offers a comprehensive benefit plan including but not limited to:
Medical & Prescription Insurance
Health Savings Account
Dental Insurance
Vision Insurance
Short and Long Term Disability
Flexible Spending Accounts
Life and Accidental Death & Disability
Accident and Critical Illness Insurance
Employee Assistance Program
401(k) Plan with Company Match
Pet Insurance
Paid Time Off. Standard first year PTO is 17 days, pro-rated based on month of hire. Enhanced PTO may be available for experienced candidates
Bonus eligible based on performance
West Bend will comply with any applicable state and local laws regarding employee leave benefits, including, but not limited to providing time off pursuant to the Colorado Healthy Families and Workplaces Act for Colorado employees, in accordance with its plans and policies.
EEO
West Bend provides equal employment opportunities to all associates and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, and promotion.
Originally posted on Himalayas