Claim Investigator

Hastings Mutual is currently looking for a Claim Investigator to join its Special Investigations Unit (SIU)! This is a great opportunity for an experienced professional with an investigative background to play a key role in reviewing claims with suspected fraudulent activity while maintaining compliance with a high level of attention-to-detail. 

The Claim Investigator examines insurance claims which may be questionable or in which fraudulent activity is suspected. The scope of investigations may include claims filed by insureds, claimants, medical providers, and various organizations requesting coverage provided under an insurance policy.

• Conducts extensive and detailed investigations of suspicious losses of varying complexity.
• Works with claim adjusters to develop and execute an SIU action plan.
• Leads in-depth interviews of participants, witnesses, or claimants in person, via phone, or through an outside vendor.
• Ensures prompt and courteous service in accordance with department and corporate standards.
• Conducts prompt, quality claim investigations that comply with legal and industry standards.
• Provides the business group with investigative information to aid in the proper resolution of claims.
• Attends examinations under oath when required.
• Searches for investigative information using various resources and databases to obtain evidence.
• Networks with fraud bureaus, law enforcement, workers compensation commissions, regulatory agencies, NICB, and others within the investigative community to share information that will lead to the discovery and prosecution of insurance fraud claims.
• Provides fraud awareness training, direction, and assistance in developing staff to ensure they have sufficient knowledge, skills, and tools to investigate claims timely and equitably.
• Directs the investigation and reviews the work product of outside vendors to ensure the company is receiving quality service and a high degree of technical expertise.
• Coordinates relevant claim information with Loss Control, Underwriting, Marketing, etc., to maximize the company’s effectiveness in avoiding future losses and to better manage current business.
• Effectively utilizes ClaimCenter to document losses to minimize the possibility of erroneous claim handling.
• Actively participates in professional development, i.e., continuing education or self-improvement.
• Other duties as assigned by leadership, either verbally or in writing.

Position Specific Details & Dimensions                                                                                    

• Uses appropriate discretion and independent judgment in daily activities with minimal oversight.
• Regularly interacts with agents, insureds, policyholders, vendors, and outside entities.
• Maintains confidentiality of claim information.
• Occasional travel including overnight stays may be required.

• A college degree is preferred or equivalent broad-based claim experience of 7-10 years, including several years within claim investigations, which can include prior insurance claim adjusting and/or prior SIU experience work. Law enforcement experience may be considered.
• Demonstrated strong analytical and observational skills. Must also be self-motivated with the ability to plan, organize, and complete tasks independently without supervision.
• Demonstrated knowledge of legal liability, general insurance policies, State Tort law and Fraud statutes.
• Strong communication skills to work well with both internal and external customers.

We value the strength of a diverse and inclusive workforce. Hastings Mutual is committed to providing equal opportunity for all employees and candidates in a work environment that does not tolerate any form of discrimination or harassment. Decisions related to employment are based on business needs, position requirements, and individual characteristics without regard to appearance, nationality, origin, race, color, religion, gender, sexual orientation, age, body, disability, veteran, family, marital status, or any legally protected class. 
 
Hastings Mutual seeks to provide reasonable accommodation to disabled individuals in the hiring process in compliance with federal, state, and local law. Candidates requiring accommodation to complete their job application or participate in the interviewing process are asked to notify the Talent Acquisition Specialist or contact us at 800-442-8277.