Senior Claims SIU Inside Investigator

The Senior Claims SIU Inside Investigator plays a critical role in identifying and investigating potential insurance fraud. This position focuses on desk-based investigations that do not require fieldwork, or where fieldwork can be delegated to SIU field investigators or external vendors.

What You’ll Do:

• Investigate suspected fraud involving clients, third-party claimants, and suppliers (e.g., auto body shops, medical treatment providers) using internal resources and SIU vendors.
• Develop initial investigation strategies and update them as needed throughout the lifecycle of each file.
• Review submitted documents for discrepancies and verify their accuracy.
• Conduct thorough, audio-recorded interviews and obtain statements from clients, witnesses, and other relevant parties.
• Coordinate and participate in examinations under oath when required.
• Identify fraud patterns, assess loss exposure, and recommend mitigation strategies.
• Perform key investigative tasks, such as obtaining official reports and consulting with experts for additional insights.
• Prepare comprehensive final reports and provide recommendations to the claims department regarding file disposition.
• Review and prioritize incoming SIU referrals based on incurred amounts, complexity, visibility, potential risk, and limitation dates.
• Assign cases within designated timeframes to appropriate SIU handlers.
• Assist in the design and delivery of customized fraud awareness, detection, investigation, and prevention training for specialized business lines, including Underwriting, Claims, and Business Development.
• Act as a subject matter expert on insurance fraud for internal teams, clients, and brokers on an ad hoc basis.
• Ensure all investigations are conducted professionally, proactively, and in good faith, with timely responses to customer and broker inquiries.
• Support industry-wide anti-fraud initiatives by attending training sessions, CASIU events, Equite committee meetings, and other relevant forums to stay current on fraud trends.
• Contribute to the review, implementation, and ongoing use of artificial intelligence tools for fraud detection, including validating outputs, tracking savings, and reporting results.

What You’ll Need to Succeed:

• Minimum 3 years of experience in insurance fraud investigations.
• Minimum 3 years of experience in claims handling.
• College or University education.
• CIP, CFEI, or CFE are preferred.
• Demonstrated expertise in conducting fraud-related investigations.
• Strong knowledge of anti-fraud practices and investigative techniques.
• Excellent analytical skills to identify patterns, quantify exposure, and develop mitigation plans.
• Proficient interviewing and statement-taking abilities.
• Strong written and verbal communication skills for reporting, training, and stakeholder engagement.
• Familiarity with industry events, ongoing training, and AI tools for fraud detection.

Location: Hybrid - We operate under a flexible hybrid work model designed to support collaboration, productivity, and work-life balance. This role is primarily based in Cambridge, Ontario, with an expectation of being on-site two days per week.

The expected base salary range for this position is $56,000 - $103,500. Depending on your relevant experience, skills, qualifications, market conditions and business needs, base compensation may vary. You have the potential to earn more through Gore Mutual’s discretionary bonus program which gives you an opportunity to increase your total compensation, provided the business meets its performance targets and you meet your individual goals.

Please note: This range reflects the expected base salary for this role but may not represent the full compensation range for all experience and skill levels. During the recruitment process, we will discuss and consider how your unique qualifications align with the broader range for this position.

Gore Mutual is proud to offer a comprehensive total rewards package which includes extended health and dental benefits, disability insurance, retirement plan matching, paid time off, recognition and perk programs.

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