Special Claims Investigator/Field Adjuster (Western Kentucky)

US-KY-Lexington
2 months ago
Job ID
22119
# Positions
1
Category
Claims
Position Type
Full Time

Overview

Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. As the people who know workers’ comp, we strive to provide an atmosphere of constant growth and development for our employees.

 

Summit provides workers’ compensation programs and services to thousands of employers throughout the Southeast.

 

Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it’s underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise.

Responsibilities

  • Conducts specific investigations for claims cases:
  • Investigates all suspect fraud referrals.
  • Secures necessary information (i.e., reports, policies, appraisals, releases, statements or other documents) to assist in the investigation of claims.
  • Identifies trends and patterns of suspected fraudulent activity.
  • Personally handles field investigations or assigns field work (i.e., surveillance, statements, etc.) to independent investigation firms.
  • Coordinates efforts with law enforcement agencies, state agencies, Claims personnel and counsel.
  • Prepares investigation reports and detailed comprehensive reports. Evaluates claims and recommends courses of action to management.
  • May provide evidence and / or testify in cases where law enforcement agencies pursue prosecution.
  • May assist in developing program awareness or conducting training on the detection, deterrence and prevention of fraud.
  • May provide guidance to less experienced staff and serve as a resource to other functional areas.
  • Performs basic searches and prepares basic reports, utilizing databases and technology that support investigations:
  • May participate in identifying enhancements to improve performance and functionality of technology applications.
  • May participate in testing the application.
  • Performs other duties as assigned.

Qualifications

  • Bachelor’s Degree or equivalent experience.
  • 3 to 5 years related experience, including Criminal Investigation or Fraud Detection experience.  Professional designation (i.e., Certified Fraud Examiner, Private Investigator license, etc.) from a recognized National Investigation Organization or State Agency preferred. 

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