Manages the day to day operations of the Fraud and Special Investigations Unit by supervising investigators, assigning and monitoring casework, providing coaching and feedback, and reviewing investigations to ensure timely completion, quality, and adherence to established policies and documentation standards.

Responsibilities 

  • Leads and independently manages SIU responses to regulatory exams, audits, and program‑level information requests, including coordinating timelines, reviewing investigative materials, preparing and submitting responses, and engaging with compliance, legal, and senior leadership as appropriate. 

  • Ensures investigations comply with applicable state insurance fraud statutes, SIU requirements, and internal compliance standards. 

  • Implements and adheres to established fraud and SIU policies, procedures, and investigative frameworks. 

  • Provides feedback and recommendations to leadership on opportunities for process improvement, efficiency, or training. 

  • Leads, mentors, and develops team members, fostering accountability and continuous improvement within the unit. 

  • Supports the improvement of team performance by tracking key performance indicators, identifying trends, and assisting with the implementation of process or workflow enhancements. 

  • Responsible for the effective use and continuous enhancement of compliance surveillance tools, investigative systems, and SIU resources, collaborating with Compliance, Technology, and business stakeholders to strengthen risk identification, investigative effectiveness, and operational efficiency. 

  • Contributes to cross‑functional initiatives and projects by providing operational and subject‑matter expertise, representing the department in working meetings, and supporting implementation efforts under the direction of senior leadership. 

 

Qualifications 

  • Bachelor’s degree in business, marketing, political science, pre-law, paralegal or other relevant area.  

  • Minimum of 5 years of experience in fraud investigations, SIU, financial crimes, claims investigations, or compliance, preferably within insurance or financial services.  

  • Demonstrated experience managing investigative teams and overseeing complex or high‑exposure cases. 

  • Excellent written and verbal communication and interpersonal skills 

 

Preferred Qualifications 

  • At least 2 years of supervisory experience are preferred.  

  • Advanced analytical, interpretive, organizational and negotiations skills.  

  • Understanding of company operations within a corporate environment. 

 

Working Conditions 

  • Office Environment 

The Salary for this position generally ranges between $102,000 - $112,000 annually. Please note that the salary range is a good faith estimate for this position and actual starting pay is determined by several factors including qualifications, experience, geography, work location designation (in-office, hybrid, remote) and operational needs. Salary may vary above and below the stated amounts, as permitted by applicable law.

Additionally, this position is typically eligible for an Annual Bonus based on the Company Bonus Plan/Individual Performance and is at the Company’s discretion