Special Claims Desk Investigator

Role overview

This opportunity is being promoted for a partner organization, which handles applications and all subsequent hiring steps. The employer is seeking a Special Claims Desk Investigator in the United States.

The role is part of a focused insurance investigations team that works to uncover, examine, and stop sophisticated fraud activity within claims operations.

You will review questionable claims behavior, including organized or coordinated claim schemes, and turn your findings into practical recommendations that help ensure claims are handled fairly and accurately.

Success in this position depends on sharp analytical judgment, thorough investigative work, and the ability to work smoothly with both internal teams and outside partners.

You will partner with claims staff, law enforcement, and external contacts to make sure suspected fraud is fully assessed and escalated when appropriate.

A major aspect of the job is spotting recurring themes, unusual patterns, and outliers in claims data to improve fraud detection capabilities.

You will also help produce investigation records, case files, and reports, and may support legal matters when needed.

This is a highly detailed, high-responsibility role in a collaborative insurance setting with a strong mission focus.

Key accountabilities

• Review suspected fraudulent claims, including referrals and more complex organized fraud or ring-related cases.
• Gather and evaluate supporting materials such as reports, policies, statements, appraisals, and other relevant evidence.
• Look for trends, irregularities, and data patterns that may point to fraudulent conduct.
• Work with law enforcement, regulatory bodies, legal counsel, and internal claims teams to support investigations.
• Write precise, well-organized investigation reports and advise management on next steps.
• Carry out or arrange field investigations, including surveillance or third-party investigative support when required.
• Help promote fraud awareness through training, shared best practices, and team education.
• Support the evaluation and improvement of fraud-detection tools, databases, and investigative technology.

Requirements

• A bachelor’s degree in Criminal Justice, Law Enforcement, Business, Liberal Arts, Computer Science, or a closely related area, or equivalent practical experience.
• Between 3 and 6 years of experience in investigations, fraud detection, insurance claims, or a similar domain.
• Solid understanding of investigation methods, evidence collection, and case-file preparation.
• Proven ability to examine complex matters and identify suspicious or fraudulent behavior patterns.
• Experience collaborating with law enforcement, regulators, and internal stakeholders.
• Strong written communication skills, especially for structured investigative documentation.
• Professional credentials such as CFE or a private investigator license are considered a strong advantage.
• Ability to work independently while handling several active investigations at once.

Benefits and compensation

The role offers a competitive annual salary of $70,000 to $80,000.

Full-time employees receive medical, dental, and vision coverage.

Additional benefits include paid time off, paid company holidays, a 401(k) plan with company matching, and an employee stock purchase plan.

Other support may include wellness programs, parental leave support, tuition reimbursement, professional development assistance, adoption assistance, commuter benefits, and flexible benefits based on role eligibility and employment type.

Application and data handling

The hiring process is managed by the partner company rather than the listing platform. The shortlist is created using an AI-assisted matching process, and the employer’s internal team makes the final hiring decisions and handles interviews or assessments.

By applying, candidates acknowledge that personal data may be processed to evaluate suitability and shared with the hiring employer under applicable data protection rules, including GDPR where relevant. Applicants may exercise rights such as access, correction, deletion, and objection. AI tools may assist with resume review, application analysis, response assessment, and verification checks, but human judgment remains central to the final decision.