claims investigator

Advantage Investigations

Experienced Insurance Claims Surveillance Investigator needed for part-time and full- time positions.Investigator will be required to take quality video and submit detailed reports.A reliable vehicle suitable for surveillance operations is required for this position. Windows should have little to no tint to allow clear visibility. Vehicles with heavy window tint are not acceptable and must have the tint removed prior to the start of employment.Applicants must have field surveillance experience in the private sector (non-security, non-military), no misdemeanor/felony record and a clean driving record. Potential candidates will be required to submit to an extensive background check. Military Veterans will receive first considerationPay commensurate to experience. Premium wage offered only to highly experienced field surveillance investigators with working knowledge of insurance investigations.Independent licensed private investigator OK but no agencies.Job Types: Full-time, Part-timePay: $20.00 - $30.00 per hourExperience:<ul><li>Field Insurance Investigation: 1 year (Required)</li></ul>Work Location: On the road

Experienced Insurance Claims Surveillance Investigator

Kemper

<div>Location(s)
Tampa, Florida
Details
Kemper is one of the nation&rsquo;s leading specialized insurers. Our success is a direct reflection of the talented and diverse people who make a positive difference in the lives of our customers every day. We believe a high-performing culture, valuable opportunities for personal development and professional challenge, and a healthy work-life balance can be highly motivating and productive. Kemper&rsquo;s products and services are making a real difference to our customers, who have unique and evolving needs. By joining our team, you are helping to provide an experience to our stakeholders that delivers on our promises.
Position Summary:
The SIU Investigator will conduct field as well as desk investigations of insurance claims referred to and accepted for investigation by the Special Investigative Unit. Our Special Investigator will function as a remote investigator working from her/his residence and servicing the Tampa and surrounding areas. Basic functions include: Investigation of claims, analysis and development of facts and evidence, and conducting and/or directing Examinations Under Oath. This investigator will coordinate investigations with outside SIU contacts, the Department of Insurance Fraud Division, NICB, and various law enforcement agencies. A laptop computer, cell phone and digital camera, MP3 recorder and other office equipment will be provided. Applicants must have the ability to travel.
Position Responsibilities:
<ul><li>Attends necessary training schools and participates in training to develop and improve skills, develops contacts, and meets state regulatory educational requirements.</li><li>
Investigates files by using appropriate field, computer and telephone investigative techniques and provides appropriate documentation of actions in a thorough timely manner.</li><li>
Maintains a diary system on all assigned files. Diary system is to be worked so that the tempo is sufficient to assure prompt and timely recommendations.</li><li>
Prepares necessary reports for state fraud bureaus and cooperates with state agencies as required by law and management. Keeps the Special Investigation Unit and field managers advised of all critical situations.</li><li>
Reports findings of all investigations and makes recommendations to the responsible manager or other designee in a timely manner to facilitate prompt decisions.</li><li>
Develops and maintains contacts with other special investigative units and fraud related organizations.</li><li>
Acquires and maintains current knowledge in all appropriate jurisdictions regarding changes in law to ensure operations are within proper parameters established by law.</li></ul>
Position Qualifications:<ul><li>
College Degree or equivalent work experience.</li><li>
Three years of insurance claims investigation experience or professional investigation experience with law enforcement agencies; or</li><li>
Five years of professional investigation experience involving economic or insurance related matters; or an authorized medical professional to evaluate medical related claims.</li><li>
Must have a working knowledge of Digital photo and document metadata and have experience with using the internet and social networking for investigative purposes.</li><li>
The candidate must possess knowledge of the principles of casualty insurance and the auto casualty claims adjustment process.</li><li>
Investigative and legal expertise needed for this position.</li><li>
Completion of the NICB Basic and/or Advanced Academies and the Reid Interviewing and Interrogation Courses are desirable.</li><li>
Must have excellent communication skills and thorough working knowledge of Microsoft office applications.</li><li>
Must demonstrate a thorough knowledge of the workings of related state and federal agencies. The SIU investigator must possess oral and written communications skills and promote a favorable company image to the public.</li><li>
Fraud Claims Law Specialist (FCLS) or Fraud Claims Law Associate (FCLA) designations and Certified Insurance Fraud Investigator (CIFI) or Certified Fraud Examiner (CFE) designations are preferred.</li><li>
A valid driver&rsquo;s license and clean driving record is required.</li></ul>
Kemper is proud to be an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, disability status or any other status protected by the laws or regulations in the locations where we operate. We are committed to supporting diversity and equality across our organization and we work diligently to maintain a workplace free from discrimination. 
 
Kemper does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Kemper and Kemper will not be obligated to pay a placement fee.
Kemper will never request personal information, such as your social security number or banking information, via text or email. Additionally, Kemper does not use external messaging applications like WireApp or Skype to communicate with candidates. If you receive such a message, delete it.</div>

Field SIU Investigator - Tampa

Allied Universal Compliance and Investigations

<div>SIU Investigator<h2 class="jobSectionHeader">
Overview</h2><div> 
Company Overview:
</div><div>Advance Your Career in Insurance Claims with Allied Universal&reg; Compliance and Investigation Services. Allied Universal&reg; Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you&rsquo;re ready to grow with the best, explore a career with us and make a difference.</div><h2 class="jobSectionHeader"> 
Job Description</h2><div> 
Allied Universal&reg; is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.</div><div>
</div><ul><li>Must possess a valid driver's license with at least one year of driving experience
</li><li>Candidate must reside in state listed in job posting
</li><li>Pay Rate: $27 - $32 / hr
</li></ul><div></div><div>RESPONSIBILITIES:</div><ul><li>
Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers&rsquo; compensation, general liability, property and casualty and disability</li><li>
Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance</li><li>
Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed</li><li>
Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct</li><li>
Run appropriate database indices if necessary and verify the accuracy of results found</li><li>
Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor</li></ul><div>
QUALIFICATIONS (MUST HAVE):</div><ul><li>
Must possess one or more of the following:</li><li><ul><li>
Bachelor&rsquo;s degree in Criminal Justice</li><li>
High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud</li></ul></li><li>
Ability to be properly licensed as a Private Investigator as required by the state where work Is completed</li><li>
Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course</li><li>
Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims</li><li>
Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.</li><li>
Proficient in utilizing laptop computers and cell phones.</li><li>
Special Investigative Unit (SIU) Compliance knowledge</li><li>
Ability to type 40+ words per minute with minimum error</li><li>
Flexibility to work varied and irregular hours and days including weekends and holidays</li></ul><div>
PREFERRED QUALIFICATIONS (NICE TO HAVE):</div><ul><li>
Military experience</li><li>
Law enforcement</li><li>
Insurance administration experience</li><li>
Familiarity with California SIU regulations</li><li>
One or more of the following professional industry certifications:</li><li><ul><li>
Certified Fraud Investigator (CFE)</li><li>
Certified Insurance Fraud Investigator (CIFI)</li><li>
Fraud Claim Law Associate (FCLA)</li><li>
Fraud Claim Law Specialist (FCLS)</li><li>
Certified Protection Professional (CPP)</li><li>
Associate in Claims (AIC)</li><li>
Chartered Property Casualty Underwriter (CPCU)</li></ul></li></ul><div>
BENEFITS:</div><ul><li>
Medical, dental, vision, basic life, AD&amp;D, retirement plan and disability insurance</li><li>
Seven paid holidays annually, sick days available where required by law</li><li>
Vacation time offered at an initial accrual rate of 3.08 hours biweekly; unused vacation is only paid out where required by law</li></ul><h2 class="jobSectionHeader"> 
Closing</h2><div> 
Allied Universal&reg; is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com
</div><div>If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.</div><h2 class="jobSectionHeader"> 
Requisition ID</h2> 
2026-1609926</div>

SIU Investigator

<div>Major Case Unit Investigator<h2 class="jobSectionHeader">
Overview</h2><div> 
Company Overview:
</div><div>Advance Your Career in Insurance Claims with Allied Universal&reg; Compliance and Investigation Services. Allied Universal&reg; Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you&rsquo;re ready to grow with the best, explore a career with us and make a difference.</div><h2 class="jobSectionHeader"> 
Job Description</h2> 
Allied Universal&reg; is hiring a Major Case Unit Investigator (MCU). MCU staff investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The Investigator must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.
RESPONSIBILITIES:<ul><li>
Use specialized services to identify new and emerging fraud trends and provide an enhanced focus on complex claims, high-risk claim exposures, such as organized crime-rings, Complex Financial Fraud Schemes, medical provider treatment fraud, medical provider billing fraud, Corporate Investigations, Case File Reviews, Anti-Fraud Consulting, and Criminal Conspiracies involving the insurance industry.</li><li>
Conduct complex Investigations across all lines of business in the insurance industry which may involve serious injuries, extensive damages, large scale or multi-party construction defect matters or complicated coverage issues.</li><li>
Analyze and interpret complex and voluminous evidence and convey highly technical information effectively to others.</li><li>
Prepare and submit detailed investigative reports as necessary and make investigative recommendations in accordance with all applicable fraud statutes, case law, and the policy contracts</li><li>
Assist clients as a subject matter expert/ expert witness, coordinate and attend Examinations Under Oath, and attend legal proceedings as required.</li><li>
Utilize the most advanced investigative techniques in the industry to include Analytics; Link Analysis; and Advanced Database and Social Media Analysis to assess suspected fraudulent claims or provider activity and create business intelligence reports that advance fraud identification and prevention efforts.</li><li>
Coordinate with local, state, and federal law enforcement and prosecutors, Department of Insurances, NICB, other carrier SIU&rsquo;s</li><li>
Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor</li></ul>
QUALIFICATIONS (MUST HAVE):<ul><li>
Must possess one or more of the following:<ul><li>
Bachelor&rsquo;s degree in Criminal Justice or a related field</li></ul></li><li>
A minimum of five years of complex criminal investigative experience as a criminal investigator, detective, and/or special agent in a full-time capacity, conducting fraud/economic related analysis. OR five (5) years of experience as a special investigator conducting insurance claim analysis and investigations with a carrier, third-party administrator and/or vendor contracted special investigations unit, plus one year conducting complex investigations.</li><li>
</li><li>Ability to be properly licensed as a Private Investigator as required by the state where you reside</li><li>
Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course</li><li>
Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.</li><li>
Proficient in utilizing laptop computers and cell phones.</li><li>
Ability to type 40+ words per minute with minimum error</li></ul>
PREFERRED QUALIFICATIONS (NICE TO HAVE):<ul><li>
One or more of the following professional industry certifications:<ul><li>
Certified Fraud Investigator (CFE)</li><li>
Certified Insurance Fraud Investigator (CIFI)</li><li>
Fraud Claim Law Associate (FCLA)</li><li>
Fraud Claim Law Specialist (FCLS)</li></ul></li></ul><div>
BENEFITS:</div><ul><li>
Medical, dental, vision, basic life, AD&amp;D, retirement plan and disability insurance</li><li>
Seven paid holidays annually, sick days available where required by law</li><li>
Vacation time offered at an initial accrual rate of 3.08 hours biweekly; unused vacation is only paid out where required by law</li></ul><h2 class="jobSectionHeader"> 
Closing</h2><div> 
Allied Universal&reg; is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com
</div><div>If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.</div><h2 class="jobSectionHeader"> 
Requisition ID</h2> 
2026-1612324</div>

Major Case Unit Investigator

Ethos

<div>
 
 About Us
 
 
 
 Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront of, we provide accurate data and actionable insights that translate into better decision-making for our clients. To learn more, visit: https://ethosrisk.com/about-us/
 
 
 
 Job Summary
 
 
 
 Have you ever thought about becoming a Private Investigator? Are you ready to kick-start your career in a rapidly growing industry? Want to get paid to learn how to investigate fraud and conduct covert surveillance in the real world? Our
 
 Full-Time Entry-Level Field Investigator
 
 position will help launch your career by providing you with an industry
 
 leading FULLY PAID Investigator Training Program - no prior experience necessary!
 
 
 
 
 Key Responsibilities
 
 
 
 <ul>
 <li>
 Case Preparation: Conduct preliminary investigations using social media and analyzing database research.
 </li>
 <li>
 Field Surveillance: Perform covert surveillance from your vehicle by tracking and capturing high-quality video evidence of surveillance targets.
 </li>
 <li>
 Report Writing: Draft detailed and court-ready investigative reports summarizing activity and key findings.
 </li>
 <li>
 Documentation: Finalize case files by submitting case reports and uploading video footage via personal laptop at the end of the day.
 </li>
 <li>
 Communication: Work closely with field supervisor, receiving regular guidance and mentorship.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Driver's License: Active driver's license that is not currently suspended or revoked.
 </li>
 <li>
 Personal Vehicle: A well-maintained vehicle that is always reliable (preferably with tinted windows). Proof of auto insurance coverage is required.
 </li>
 <li>
 Travel Expectations: While we aim to keep assignments within a reasonable drive of your residence, occasional further travel and overnight stays (covered by the company) may be required.
 </li>
 <li>
 Technology: A reliable laptop, cell phone, and internet service are needed for communication and administrative tasks.
 </li>
 <li>
 Required Skills: Strong computer &amp; internet proficiency. Excellent communication, verbal &amp; writing skills.
 
 
 </li>
 </ul>
 
 What We Offer
 
 
 
 <ul>
 <li>
 Paid Investigator Training Program: Fully paid training program led by industry experts with ongoing development and support. Initial training will be held via virtual classroom then transition into on-the-job training.
 </li>
 <li>
 Paid Licensing: We pay for all your licensing fees! Our licensing team will guide you through the process of acquiring all investigator licensing to ensure a smooth process.
 </li>
 <li>
 Surveillance Equipment: We will provide you with necessary surveillance equipment. After a year of employment, it is yours to keep!
 </li>
 <li>
 Pay Increases &amp; Milage Reimbursement: There are several performance milestones within your training &amp; first year of employment that will reward you with pay increases. Additionally, we offer a mileage reimbursement program.
 </li>
 <li>
 Health Insurance/Retirement: Medical, Dental Vision, Life/Disability Insurance + 401k
 
 
 </li>
 </ul>
 
 Working Conditions
 
 
 
 <ul>
 <li>
 Most surveillance cases start at 6:00AM. End time can vary depending on activity and a typical workday can vary from 3-12 hours.
 </li>
 <li>
 Weekends/holidays are common workdays as claimants are more likely to be active.
 </li>
 <li>
 This is an independent role often requiring long hours alone in your vehicle, regardless of weather conditions.
 </li>
 <li>
 Must remain alert with no external distractions, ready to use videography equipment to document subjects.
 
 
 </li>
 </ul>
 
 Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic.
 
 
 
 A background check will be conducted, in accordance to the local state law and regulations.
 
 
 Salary: $23 per hour
 
 
 
 
 Job Posted by ApplicantPro
 
 
</div>

Entry-Level Investigator

Ethos Risk Services

<div>ABOUT US:
Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront, we provide accurate data and actionable insights that translate into better decision-making for our clients. 
JOB SUMMARY:
Our dynamic Ethos team is seeking a Special Unit Investigations (SIU) Field Investigator to conduct field investigations, gather and analyze evidence, and produce detailed reports that support claims decisions. You'll work both independently and collaboratively, often traveling to accident scenes, interviewing witnesses, and uploading documentation into our claims system. 
KEY RESPONSIBILITIES:<ul><li>
Scene Investigations: Conduct thorough on-site investigations of accidents and property losses.</li><li>
Interviews &amp; Statements: Conduct in-person interviews and obtain accurate, detailed statements from all parties involved.</li><li>
Online Research: Gather case information through digital sources and background checks.</li><li>
Report Writing: Draft thorough, detailed investigative reports summarizing findings and observations.</li><li>
Case Documentation: Conduct in-person interviews and obtain accurate, detailed statements from all parties involved, and retrieve relevant documents to support investigative findings.</li><li>
Case Management: Track case progress, time, and expenses accurately within Ethos systems.</li><li>
Fraud Detection: Recognize compensability issues, misrepresentation, and other red flags in claims.</li><li>
Client Communication: Maintain professional contact with clients and claim handlers throughout the investigation process.</li></ul> 
QUALIFICATIONS:
Education: Associate's or Bachelor's degree in Criminal Justice or a related field preferred.
Experience:<ul><li>
Minimum of 2 years of SIU experience with an investigative firm or insurance carrier, working across various lines of business such as liability, auto, and property.</li><li>
Former military or law enforcement background preferred.</li></ul>
Licenses/Certifications:<ul><li>
Active Private Investigator license or willingness to obtain one (where required by state).</li><li>
Active driver's license and valid auto insurance.</li></ul>
Other Requirements:<ul><li>
A well-maintained and reliable vehicle for exclusive use.</li><li>
SIU equipment, including a recorder and a high-quality digital camera.</li><li>
A reliable laptop, cell phone, and internet service are needed for communication and administrative tasks.</li></ul> 
WORKING CONDITIONS:<ul><li>
While we aim to keep assignments within a 2-hour drive of your residence, occasional further travel and overnight stays (covered by the company) may be required.</li><li>
Occasional weekend work may be required to align with case demands and or/client requests.</li></ul> 
Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic.</div>

Special Investigations Unit (SIU) - Field Investigator

Plymouth Rock Assurance

<div>We are seeking a highly skilled and motivated candidate with specialized experience in NJ provider/PIP initiatives to join our team in order to assist with Major Case Investigation. The ideal candidate will have a strong background in identifying, investigating, and resolving complex cases of insurance fraud within the Personal Injury Protection (PIP) and healthcare provider space. Proficiency in investigative techniques, industry regulations, and PIP claim regulations is essential.

RESPONSIBILITIES
<ul>
<li>Lead and conduct comprehensive investigations into major fraud cases, including healthcare fraud, staged accidents, exaggerated injuries, and fraudulent billing practices related to PIP claims.</li>
<li>Analyze and review claims data to identify red flags, trends, and patterns indicative of fraudulent activity, particularly focusing on NJ provider claims.</li>
<li>Collaborate with internal teams, external stakeholders, and law enforcement agencies to gather evidence and build cases.</li>
<li>Interview witnesses, claimants, and providers as part of the investigative process, documenting findings thoroughly.</li>
<li>Provide detailed reports and recommendations on cases for potential legal action or denial of claims.</li>
<li>Stay current with NJ PIP regulations, fraud detection techniques, and industry best practices.</li>
<li>Work closely with legal, compliance, and claims teams to ensure that investigative findings align with company policies and regulatory requirements.</li>
<li>Provide testimony and expert witness support in legal proceedings when necessary.</li>
</ul>
QUALIFICATIONS
<ul>
<li>Minimum of 5 years of experience in insurance fraud investigation, with a focus on PIP claims and NJ provider networks.</li>
<li>Proven expertise in the detection, investigation, and resolution of complex fraud cases in the insurance or healthcare industry.</li>
<li>Strong understanding of New Jersey PIP laws, regulations, and claims processing.</li>
<li>Proficiency in utilizing investigative tools, claims management software, and fraud detection systems.</li>
<li>Excellent written and verbal communication skills, with the ability to present complex findings clearly and effectively.</li>
<li>Ability to work independently, manage multiple investigations simultaneously, and meet deadlines.</li>
<li>Strong analytical and problem-solving skills.</li>
<li>Bachelor's degree or equivalent experience in criminal justice, insurance, or a related field.</li>
</ul>
SALARY RANGE

The pay range for this position is $70,000 to $103,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.
PERKS &amp; BENEFITS
<ul>
<li>4 weeks accrued paid time off, 8 paid national holidays per year, and 2 floating holidays</li>
<li>Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision)</li>
<li>Annual 401(k) Employer Contribution</li>
<li>Free onsite gym and health center at our Woodbridge Location
</li><li>Resources to promote Professional Development (LinkedIn Learning and licensure assistance)
</li><li>Robust health and wellness program and fitness reimbursements</li>
<li>Various Paid Family leave options including Paid Parental Leave</li>
<li>Tuition Reimbursement
</li></ul>ABOUT THE COMPANY

The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of &ldquo;A-/Excellent&rdquo;.</div>

Claims Representative, SIU

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