Claims Fraud Investigator

About the Claims Fraud Investigator Role at Zurich North America

At Zurich North America Claims, we value work-life balance and flexibility. Our hybrid model offers autonomy for individual work while supporting valuable in-person collaboration when beneficial. Occasional in-office attendance is expected. This remote role is open to candidates residing in Arizona, Florida, Georgia, Illinois, Missouri, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.

As a Claims Fraud Investigator, you will operate under general direction, within defined authority limits, to conduct complex insurance fraud investigations. This includes cases involving intricate schemes, multi-claim patterns, organized criminal activity, and non-medical major case work. Your responsibilities will encompass field activities, coordinating vendor resources, conducting interviews, gathering evidence, and delivering clear, objective, and fact-based investigative reports. You may also provide support for California and travel insurance-related investigations as needed.

Primary Responsibilities

• Conduct 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 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; 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 investigative actions and findings.
• Analyze evidence to determine potential misrepresentation, fraud, or network linked activity involving multiple claims.
• Prepare clear, comprehensive investigative reports with objective findings and 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 complies with SIU regulatory requirements, privacy laws, and Zurich governance standards.
• Travel as necessary to conduct interviews, inspections, and field investigations.

Qualifications

Basic 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 AND
• 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

Compensation and Benefits

Your compensation at Zurich is determined by your role, location, skills, and experience, adhering to local fair compensation laws. You may also be eligible for bonuses and merit increases. The proposed salary range for this position is $65,900.00 - $107,900.00, with short-term incentive bonus eligibility set at 10%. We offer competitive pay and comprehensive benefits for employees and their families.

Why Zurich North America?

Zurich North America values your ideas and experience, offering growth opportunities, an inclusive culture, and a supportive environment to help shape the future of insurance. As a leader in risk management with over 150 years of expertise, Zurich covers 25+ industries, including 90% of the Fortune 500®. Join us for a brighter future for yourself and our customers. Zurich North America is an Equal Opportunity Employer.

Key skills/competency

• Insurance Fraud
• Investigative Reporting
• Open Source Intelligence
• Link Analysis
• SIU Regulations
• Evidence Gathering
• Interviewing Techniques
• Claims Processes
• Vendor Management
• Regulatory Compliance