Senior (Special Investigation Unit (SIU) Investigator

Overview

How You’ll Work Work Solution: Hybrid Relocation Eligibility: Available

Responsibilities

What You’ll Do We are seeking a seasoned and strategic Senior Special Investigation Unit (SIU) Investigator to lead the proactive detection, prevention, and resolution of fraudulent activities impacting our life insurance products and services. This role is critical to safeguarding the financial integrity of the organization, ensuring compliance with regulatory requirements, and protecting the trust placed in us by policyholders, beneficiaries, and stakeholders. The ideal candidate will bring deep investigative expertise, a strong understanding of life insurance operations, and a demonstrated commitment to ethical conduct, sound judgment, and continuous improvement.

• Lead complex, high-exposure, and multi-jurisdictional fraud investigations across life insurance, annuity and travel & accident products, including application, underwriting, claims, and identity-related fraud schemes.
• Direct end-to-end case strategy, overseeing evidence development, investigative approach, and resolution for regulatory and criminal matters.
• Manage criminal and regulatory referrals, coordinating with Departments of Insurance, fraud bureaus, and law enforcement to support prosecution and compliance obligations
• Serve as a subject matter expert on insurance fraud schemes, statutes, and regulatory requirements, providing guidance on high-risk and sensitive matters while ensuring investigations meet legal, regulatory, and ethical standards.
• Mentor and coach SIU investigators and fraud analysts, providing technical direction and developing investigative best practices.
• Develop and enhance fraud detection methodologies by leveraging advanced analytics, data mining, and investigative tools, and prepare comprehensive investigative reports with recommendations.
• Partner with internal teams and external organizations to assess fraud exposure, implement mitigation strategies, monitor emerging fraud trends, and support coordinated prevention efforts

Position Success Criteria

• Results Orientation / Strategic Execution: Leads complex investigations with urgency and extremely high effectiveness, prioritizing high-risk matters, driving outcomes, and delivering high-quality results in a fast-paced, high-exposure environment.
• Customer and Business Focus: Balances member experience, business objectives, and fraud risk, proactively identifying exposures, removing barriers, and strengthening fraud prevention and detection across the Company.
• Communication, Influence and Leadership: Communicates complex investigative findings clearly and persuasively to leadership, legal and regulatory audiences. Influences decision-making and provides credible guidance on sensitive matters.
• Technical and Professional Expertise (Fraud & Regulatory): Serves as the subject matter expert in insurance fraud, with advanced knowledge of fraud schemes, investigative techniques, analytics, and applicable laws, rules and regulations. Also, translates insights into actionable strategies and control improvements.
• Decision Quality and Investigative Judgment: Exercises sound, independent judgment in a high risk and potentially contentious situations; leads investigative strategy, makes defensible decisions, and provides expert recommendations on matters referred for prosecution, regulatory reporting and case resolution.

Qualifications

Qualifications

• Bachelor’s degree in Criminal Justice, Insurance, Finance, or a related field required, advanced degree preferred.
• Minimum 8 years of progressive fraud investigation experience, with significant experience in life insurance, annuities, travel & accident products, or financial services environment.
• Deep knowledge of life insurance and annuity products, including the full policy lifecycle (from application, underwriting, policy servicing, and claims) and associated fraud risks. 8 ormore years’ experience preferred.
• Advanced understanding of insurance fraud statutes, SIU regulations, regulatory reporting requirements, and multi-jurisdictional investigative considerations.
• Demonstrated expertise in complex fraud investigations, including high exposure, organized, or fraud-sophisticated schemes.
• Advanced analytical skills with demonstrated ability to evaluate large, complex data sets and translate findings into actionable investigative strategies.
• Exceptional interpersonal, written, and verbal communication skills, including the ability to articulate complex findings to executive, legal and regulatory audiences.
• Proven ability to handle sensitive investigations with discretion, integrity, and sound ethical judgment.

Preferred Qualifications

• Prior law enforcement, regulatory or SIU liaison experience of 8 years or more, is a plus. Professional certification(s) strongly preferred (e.g., Certified Fraud Examiner (CFE), Fraud Claim Law Specialist (FCLS), Associate, Life and Health Claims Designation (ALHC), or CFCI (Certified Financial Crimes Investigator – IAFCI).
• Knowledge and proficiency with fraud detection and case management systems a plus, (e.g., SAS Fraud Management, GIACT, IBM i2 Analyst’s Notebook, or equivalent tools).
• Experience testifying in criminal, civil, or administrative proceedings, including depositions and court hearings.
• Active involvement in industry fraud prevention organizations and a strong network of investigative contacts.

While performing the duties of this job, the employee is frequently required to stand, walk, sit, use hands and fingers to handle, or feel, talk, hear, and concentrate. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodation will be made for otherwise qualified applicants as needed to enable them to fulfill these requirements. Apply To This Job