Senior Special Claims Investigator - Worker's Comp (Illinois Field) (Open)

Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. As the people who know workers’ comp, we strive to provide an atmosphere of constant growth and development for our employees.
 
Summit provides workers’ compensation programs and services to thousands of employers throughout the Southeast.
 
Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it’s underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise.

Essential Job Functions and Responsibilities

• Detects and prevents fraudulent claims through meticulous investigation and complex analysis.
• Analyzes and interprets data to identify inconsistencies, potential fraud, and the overall legitimacy of claims.
• Prepares comprehensive reports summarizing investigation findings and recommends claim approval or denial. Evaluates claims and may recommend courses of action to management.
• Ensures claims are settled accurately and fairly, minimizing fraudulent activities and protecting the company’s financial interests.
• May present evidence and/or deliver testimony in situations where law enforcement agencies seek prosecution.
• Contributes to the continuous improvement of investigation processes and techniques, enhancing overall efficiency and effectiveness.
• May contribute to the development of program awareness initiatives or facilitate training sessions focused on the detection, deterrence, and prevention of fraudulent activities.
• Performs other duties as assigned.
• The individual hired for this field position will manage the Illinois territory

Job Requirements

Education: Bachelor’s Degree in Criminal Justice, Risk Management and Insurance, Business Administration, or a related field or equivalent experience.

Experience: Generally, a minimum of 6 years of experience, including Criminal Investigation or Fraud Detection experience.  Continuing progress toward and/or the completion of a professional designation preferred, such as Certified Insurance Fraud Investigator (CIFI), Certified Fraud Examiner, or Private Investigator license from a National Investigation Organization or State Agency.

Scope of Job/Qualifications: Works within broad limits and authority on assignments of highly complex technical complexity and coordination. Strong knowledge of Claims investigation laws and regulations. Ability to identify and address subtle details that could impact the outcome of an investigation. Demonstrated advanced ability to organize and prioritize caseloads, ensuring timely completion of investigations. Excellent interpersonal and communication skills to collaborate with appropriate parties to ensure thorough and accurate claims settlements. Proven ability to handle confidential information with discretion. Excellent analytical skills with the ability to use data to analyze situations, identify problems, and develop effective solutions.

Company:

Salary Range:

Benefits:

Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.

We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.

Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.