Job Description

SIU - Complex Major Case Investigator

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Overview

The SIU - Complex Major Case Investigator is a cornerstone of our fraud defense strategy. This role moves beyond traditional case investigation to proactively identify, analyze, and dismantle complex fraudulent networks targeting the organization. By leveraging all-source data, advanced analytics, and collaborative partnerships, this position provides actionable intelligence that protects company assets, ensures regulatory compliance, and supports high-stakes legal proceedings. The ideal candidate is an expert in both investigative techniques and data interpretation, capable of turning raw information into strategic insight.

Responsibilities

Investigation & Case Management

* Conduct complex investigations into suspected fraudulent claims and schemes involving claimants, providers, policyholders, and internal parties.

* Gather, preserve, and analyze critical evidence from a wide array of sources, including financial records, digital forensics, surveillance, social media, and public/private databases.

* Prepare detailed, clear, and concise investigative reports suitable for internal claims decisions, law enforcement referrals, and courtroom testimony.

* Manage a dynamic caseload efficiently, working both independently and as a collaborative team member to meet deadlines and objectives.

Intelligence & Data Analysis:

* Proactively monitor fraud activity across all products and channels, applying statistical analysis to identify emerging patterns, trends, and systemic vulnerabilities before they escalate.

* Apply all-source research, collection, and analysis techniques to illuminate fraudulent networks, their key players, and methodologies.

* Continuously evaluate new data sources and vendor tools to uncover novel fraud patterns and enhance the evolution of our predictive models and fraud detection strategies.

* Provide timely and actionable intelligence briefings to leadership on fraud trends, tool effectiveness, and the overall threat landscape.

Collaboration & Disruption:

* Collaborate closely with Claims, Underwriting, and Audit departments to provide investigative expertise and ensure a cohesive strategy.

* Serve as a key liaison with external partners, including law enforcement, regulatory agencies (NICB, state fraud bureaus), and legal counsel, to disrupt and dismantle fraudulent networks.

* Partner with vendors, product managers, and digital teams to refine and improve the accuracy of fraud detection rules, alerts, and analytical models.

Compliance & Integrity:

* Ensure all investigative and analytical activities are conducted in strict compliance with relevant fraud statutes, privacy laws (e.g., GLBA), and regulatory reporting requirements.

* Uphold the highest ethical standards, maintaining absolute confidentiality and integrity in all matters.

Qualifications

* Bachelor's degree in criminal justice, data analytics, intelligence studies, or a related field.

* Minimum of 5-7 years of professional experience in complex insurance fraud investigations (Commercial, P&C, Workers' Compensation), law enforcement, or intelligence analysis.

* Demonstrated expertise in conducting all-source intelligence gathering and applying analytical techniques to complex investigations.

* Strong analytical and quantitative skills with a proven ability to interpret large datasets, identify patterns, and make data-driven decisions.

* Proficiency with investigative databases, social media analysis, and data visualization tools is highly preferred.

* Exceptional written and verbal communication skills, with the ability to present complex information clearly to diverse audiences.

* Proven ability to operate with a high degree of autonomy, initiative, and discretion.

* A strong understanding of insurance principles, fraud statutes, and privacy regulations.

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

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