Job Description

Role Description

The Fraud Analyst works in support of the EMPLOYERS' Special Investigations program goal to both protect EMPLOYERS against the adverse financial impact of workers' compensation fraud and to ensure compliance with federal, state, and local anti-fraud statutory/regulatory mandates. The Fraud Analyst provides essential administrative and analytical support to the SIU team by performing data research, maintaining investigation records, preparing reports, and identifying patterns or anomalies in claims data that may indicate fraudulent activity.

• Provides administrative and operational support to the SIU team, including maintaining case files, tracking deadlines, and coordinating case-related documentation.
• Conducts basic data research and analysis using internal systems, industry databases, and public records to support active investigations.
• Completes social media, industry-related database, and other public information searches as directed by SIU Leadership.
• Assists in the identification of potential fraud red flags by reviewing claims data and flagging anomalies for investigator review.
• Collects, organizes, and maintains investigation-related records, evidence logs, and supporting documentation.
• Prepares written summaries, data reports, and analytical findings for use by SIU investigators and management.
• Identifies and utilizes the most cost-effective database and research tools available.
• Complies with local, state, and federal regulations involved with accessing, retrieval, and storage of public and database-available information.
• Adopts new processes, technologies, and workflow changes with a positive and proactive mindset.
• Continuously monitors own workload quality, seeking clarification or training when necessary to improve outcomes and consistency.
• Exercises due diligence at all times to protect EMPLOYERS against any unnecessary risks associated with the investigatory process.
• Assists with the preparation of periodic and ad-hoc production reports for SIU management.
• Participates in SIU associations, seminars, and training opportunities to maintain current knowledge of fraud trends and investigative tools.
• Other duties may be assigned.

Qualifications

• Associate’s degree or equivalent combination of training/experience preferred.
• Minimum of 1 year of combined experience from any of the following areas:
  • Workers’ Compensation Insurance fraud investigations
  • Governmental insurance oversight
  • Property and Casualty Claims
  • Property and Casualty Premium Audit
  • Law enforcement
  • Loss Control
• Knowledge of Workers’ Compensation claims processes and regulations preferred.
• Possess strong analytical, tracking, and monitoring skills with attention to detail.
• Ability to effectively communicate in a collaborative environment, using various technology tools.
• Possess strong oral and written communication, listening, interpersonal, customer service, and telephone skills.
• Must be self-motivated with the ability to work independently and within a team environment.
• Possess the ability to multi-task, identify the importance of each task and issue, adhere to deadlines, and complete assignments accordingly.
• Excellent problem-solving and decision-making skills and the ability to remain professional in all situations.
• Ability to maintain confidentiality.
• Computer skills (MS Office, Internet searches, industry database familiarity, etc.).
• Valid state driver’s license and good driving record.

Requirements

• Remote: This role is a remote (work from home (WFH) opportunity) and only open to candidates currently located in the United States and able to work without sponsorship.
• It requires a suitable space that provides a private and quiet workplace.
• Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
• Travel: May be required to travel to off-site location(s) to attend meetings, as necessary.

Benefits

• Hourly Pay Range: $23.00 - $32.00 per hour.
• A comprehensive benefits package, please follow the link to our benefits page for details!

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