Claims Fraud Investigator

At Zurich North America Claims, we recognize that work–life balance and flexibility are important priorities when considering your next career move. Our hybrid work model is designed with employees’ needs in mind, providing the flexibility to perform individual work from your preferred location while supporting valuable, in person collaboration when beneficial. While the model offers a high level of autonomy, occasional in office attendance should be expected. The candidate selected for this role should be able to work remotely from one of the following states: Arizona, Florida, Georgia, Illinois, Missouri, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia. 

Under general direction and within defined authority limits, this role is responsible for conducting insurance fraud investigations involving complex schemes, multi claim patterns, organized activity, and non medical major case work. The investigator will perform field activities, coordinate vendor resources, conduct interviews, gather evidence, and deliver clear, objective, and fact based investigative reports. This role may also support California and travel insurance related investigations as needed.

Field travel may be required to conduct interviews, scene examinations, statement collection, evidence gathering, examinations under oath, and support legal proceedings.

Primary Responsibilities:

• Conduct investigations into suspected insurance fraud within assigned territories or Lines of Business, including complex, layered, or organized schemes.
• Evaluate all aspects of referred claims, including loss circumstances, backgrounds of involved parties, documentation validation, and underwriting considerations.
• Perform database research, open source intelligence reviews, social media assessments, and link analysis to identify inconsistencies or coordinated fraud indicators.
• Assign and oversee vendor activities such as surveillance, scene investigations, and specialized investigative tasks; review deliverables and ensure proper documentation.
• Conduct recorded interviews, site visits, canvasses, and other investigative steps to verify material facts and identify fraud indicators.
• Maintain highly organized case files and documentation that accurately reflect investigative actions and findings.
• Analyze evidence to determine potential misrepresentation, fraud, or network linked activity involving multiple claims.
• Prepare clear, comprehensive investigative reports with objective findings and recommendations for claims teams and management.
• Communicate critical investigative developments promptly and collaborate closely with claims partners throughout the investigative process.
• Identify cases that warrant escalation due to suspected organized fraud rings, staged events, or potential law enforcement involvement.
• Ensure all investigative activity complies with SIU regulatory requirements, privacy laws, and Zurich governance standards.
• Travel as necessary to conduct interviews, inspections, and field investigations.

Basic Qualifications:

• Bachelor’s Degree and 4 or more years of experience in Technical Claims Investigations, Law Enforcement, or Insurance Special Investigations
  OR
• Zurich Certified Insurance Apprentice (Associate Degree) and 4 or more years of relevant experience
  OR
• High School Diploma or Equivalent and 6 or more years of experience in Technical Claims Investigations, Law Enforcement, or Insurance Special Investigations
  AND
• Knowledge of claims processes and relevant fraud related regulations
• Proficiency in Microsoft Office

Preferred Qualifications:

• 5 or more years investigating insurance fraud (field SIU experience preferred)
• Experience with both single non complex investigations and complex investigations, including multi claim linkages, contractor or vendor fraud, or organized fraud networks

Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply—your unique background matters to us. The pay range shown is a national average and may vary by location. The proposed Salary range for this position is 65,900.00 - $107,900.00, with short-term incentive bonus eligibility set at 10%.

We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.]

Why Zurich?

At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment—so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500®.

Join us for a brighter future—for yourself and our customers.

Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets.

Zurich complies with 18 U.S. Code § 1033.

Please note: Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal.

Location(s): AM - Georgia Virtual Office, AM - Arizona Virtual Office, AM - Florida Virtual Office, AM - Illinois Virtual Office, AM - Missouri Virtual Office, AM - North Carolina Virt. Office, AM - Pennsylvania Virtual Office, AM - South Carolina Virt. Office, AM - Tennessee Virtual Office, AM - Texas Virtual Office, AM - Virginia Virtual Office
Remote Working: Yes
Schedule: Full Time
Employment Sponsorship Offered: No 
 
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