Special Investigations Representative

Special Investigation Representative

SFM - The Work Comp Experts

About SFM

Since 1983, SFM's mission has been to be the workers' compensation partner of choice for agents, employers, and their workers. While we've expanded to over 25,000 customers in the Midwest, and have grown our offerings to include vocational rehab, loss prevention, medical services (and more!), our focus continues to be unrivaled customer service, injury prevention, and results. SFM is unique in that we are small enough that your voice is heard, but has all the benefits and perks of a larger employer. We value your opinion, help you reach your goals, and make it easy for you to maintain work-life balance.SFM's benefits include generous PTO, 9 paid holidays, student loan payback program, internet reimbursement and excellent health insurance, 401k match and bonus opportunities.

Apply today and you will discover why SFM retains their employees and is considered an excellent place to grow your career. Find out why our employees rate us a top employer and choose to stay and grow with us. Visit our careers page to learn more about working at SFM

What You Will Be Doing

1. Gathers and evaluates data from multiple internal and external sources to identify and investigate potential fraudulent insurance acts.
2. Demonstrates an understanding of common fraud schemes and develops anti-fraud actions to protect the company.
3. Prepares detailed investigative reports and evaluation summaries for claims representatives, attorneys, or other company representatives.
4. Uses software analysis tools and other resources to conduct investigations and proactively identify aberrant patterns and/or suspected fraud, waste or abuse practices. Interprets and analyzes complex data and identifies and eliminates false positive data.
5. Follows up on investigative leads and develops investigative strategies using independent judgment, initiative and sound decision-making skills.
6. Works with surveillance firms to coordinate surveillance investigations, and will manage the process from start to finish.
7. Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection and prevention.
8. Models ethical behavior and executes job responsibilities in accordance with SFM core values and Code of Business Ethics.
9. Stays apprised of social media channels, current internet activity trends, and evolving potential open-source-data research websites.
10. Attends meetings with claims representatives, attorneys and managers to offer strategic investigative ideas to address suspicions of insurance fraud and to present optional actions to take to address proven fraudulent activity.
11. Communicates fraudulent claim details to the NICB- and state fraud departments. Assists with criminal prosecution investigations- and develops evidence needed to prove criminal activities as required by state prosecutors.
12. Creates and delivers presentations on subjects of subrogation and fraud.
13. Acquires and applies knowledge of state laws & regulations pertaining to insurance fraud and seeks opportunities to improve strategies that impact investigative efforts and results.
14. Acts as a resource for business units, policyholders, agents, and legal counsel, to achieve financial, individual, and team goals.

What We'll Love About You

• Associate Degree in Criminal Justice, or similar field.
• Bachelor's Degree in criminal justice, risk management, paralegal, police science, computer forensics, psychology or a similar field, strongly preferred.
• Two years investigative experience involving insurance claims, insurance law, criminal law or similar subject matter.
• Advanced computer skills.
• Distinctive desire to research and investigate.
• Experienced user of social media websites.
• Expert understanding of internet search-engine search functions.
• Strong written and verbal communication skills.
• Critical thinking skills.
• Excellent written and verbal communication skills with the innate ability -to communicate with a diverse group of people.
• Able to assimilate, understand and analyze information from a variety of sources
• Excellent conflict management skills.
• Confidentiality apprehension and application.
• Strong analytical, puzzle-solving and decision-making skills.
• Effective prioritization, organization and time management skills.
• Strong customer service and interpersonal skills.
• Demonstrates positive teaming skills focused on team results.

Physical Requirements

Regular attendance is required. Work takes place in a semi paperless environment within an office setting, using standard office equipment such as computers, phones, and photocopiers, which requires being stationary for extended periods of time.While performing the duties of this job, the employee is regularly required to talk or hear, and maintain concentration and focus. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions. **Travel as needed.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. SFM provides equal employment opportunities to all employees 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, status with regard to public assistance, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

SFM Companies, EEO/AA Employers. SFM is a participant of E-Verify. Applicants have rights under Federal Employment Laws.