Claims Fraud Investigator

About the Claims Fraud Investigator Role at Zurich Insurance

At Zurich North America Claims, we blend work-life balance with flexibility through our hybrid work model. This role offers the autonomy to work remotely from one of several designated states, balanced with occasional in-office collaboration when beneficial. As a Claims Fraud Investigator, you will operate under general direction, within defined authority limits, to conduct complex insurance fraud investigations. This includes delving into intricate schemes, multi-claim patterns, organized criminal activity, and non-medical major case work.

The investigator will be responsible for field activities, coordinating vendor resources, conducting interviews, gathering crucial evidence, and delivering clear, objective, and fact-based investigative reports. This position may also support California and travel insurance-related investigations as required, and field travel will be necessary for interviews, scene examinations, statement collection, evidence gathering, examinations under oath, and supporting legal proceedings.

Primary Responsibilities

• Conduct thorough investigations into suspected insurance fraud within assigned territories or Lines of Business, focusing on complex, layered, or organized schemes.
• Evaluate all aspects of referred claims, including loss circumstances, backgrounds of involved parties, documentation validation, and underwriting considerations.
• Perform comprehensive database research, open-source intelligence reviews, social media assessments, and link analysis to identify inconsistencies or coordinated fraud indicators.
• Assign and oversee vendor activities such as surveillance, scene investigations, and specialized investigative tasks; meticulously review deliverables and ensure proper documentation.
• Conduct recorded interviews, site visits, canvasses, and other investigative steps to verify material facts and identify fraud indicators.
• Maintain highly organized case files and documentation that accurately reflect all investigative actions and findings.
• Analyze gathered evidence to determine potential misrepresentation, fraud, or network-linked activity involving multiple claims.
• Prepare clear, comprehensive investigative reports with objective findings and actionable recommendations for claims teams and management.
• Communicate critical investigative developments promptly and collaborate closely with claims partners throughout the investigative process.
• Identify cases that warrant escalation due to suspected organized fraud rings, staged events, or potential law enforcement involvement.
• Ensure all investigative activity strictly complies with SIU regulatory requirements, privacy laws, and Zurich governance standards.
• Travel as necessary to conduct interviews, inspections, and field investigations.

Required Qualifications

• Bachelor’s Degree and 4 or more years of experience in Technical Claims Investigations, Law Enforcement, or Insurance Special Investigations; OR
• Zurich Certified Insurance Apprentice (Associate Degree) and 4 or more years of relevant experience; OR
• High School Diploma or Equivalent and 6 or more years of experience in Technical Claims Investigations, Law Enforcement, or Insurance Special Investigations.
• Knowledge of claims processes and relevant fraud-related regulations.
• Proficiency in Microsoft Office.

Preferred Qualifications

• 5 or more years investigating insurance fraud (field SIU experience preferred).
• Experience with both single non-complex investigations and complex investigations, including multi-claim linkages, contractor or vendor fraud, or organized fraud networks.

Key Skills/Competency

• Insurance Fraud Investigation
• Claims Analysis
• Evidence Gathering
• Interviewing Techniques
• Report Writing
• Open Source Intelligence
• Regulatory Compliance
• Link Analysis
• Vendor Management
• Law Enforcement Collaboration