Claim Investigator

A career at The Auto Club Group (ACG) can be satisfying, exciting and rewarding. By aligning your professional development with our business objectives, ACG can help you attain your career goals — and make a difference. Get started by choosing the career that’s right for you.

Tampa, FL

The Auto Club Group

AAA was founded over 100 years ago for the purpose of lobbying for driver and passenger rights, fair laws and safer vehicles — all to better promote the love of the open road and the adventure of driving. Since then, AAA has grown to over 50 million members strong, while providing valuable membership services such as roadside assistance. Additionally, AAA has broadened its horizons to include all types of travel-related services, as well as offer a variety of insurance and financial products and services. Today’s AAA is a national federation comprised of more than 50 individual clubs throughout the United States and Canada. Whether you’re traveling around the world or to the corner grocery store, planning a honeymoon or weekend road trip, learning to drive or in need of a battery boost, the best way to begin your journey is with AAA.

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Competitive Compensation and Benefits Package

Overview: The Auto Club Group (ACG) provides membership, travel, insurance, and financial services offerings to approximately 9 million members and customers across 11 states and 2 U.S. territories through the AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.
Responsibilities: <ul> <li>Independently perform comprehensive assessment and investigation of personal lines property, home and auto claims for the potential of claim fraud.</li> <li>Maintain a thorough understanding of insurance policies and claim handling practices and procedures, as well as insurance policy eligibility and underwriting requirements.</li> <li>Maintain a comprehensive understanding of claim fraud, including the fraud scenarios and methods by which insureds, claimants, and other parties may engage in opportunistic fraud.</li> <li>Understand and comply with state laws, regulations, and case law impacting claim fraud and investigation activities.</li> <li>Contact the claim representative assigned to the claim, work with them collaboratively, and keep them informed throughout the claim investigation.</li> <li>Review claims to identify the potential fraud scenarios that might be present, both for claim fraud and also policy premium fraud.</li> <li>Complete investigative activities that will help prove or disprove the presence of fraud.</li> <li>Investigative activities may include identifying insureds, claimants, witnesses and other parties and completing interviews or recorded statements.</li> <li>Obtain customer records such as utility bills and other documents pertinent to the investigation and when necessary with the permission of the insured.</li> <li>Complete vehicle inspections or home inspections.</li> <li>Obtain and follow-up on public records, as well as the police, fire, and other official reports.</li> <li>Arrange for and attend Examinations Under Oaths.</li> <li>Obtain legal counsel opinion when necessary.</li> <li>Attend court hearings when necessary.</li> <li>Investigative activities may also involve hiring experts for specialized tasks such as home fire cause and origin analysis, vehicle accident reconstruction and legal counsel, and managing those vendors through setting clear expectations, monitoring results, and reviewing and paying associated expenses.</li> <li>Complete investigations thoroughly but also balance expense costs against the facts and exposure of the claim.</li> <li>Thoroughly document investigative activities, results, and evidence.</li> <li>Work collaboratively with law enforcement, other insurance carrier special investigation units, attorneys, and other parties. Prepare written investigative summaries, and report findings to the assigned claim handler, management, Underwriters, and others.</li> <li>Promote fraud awareness and expertise through liaison, consulting, collaboration, and training of company personnel when assigned.</li> </ul>
Requirements: <div><strong><span style="font-family: Arial; font-size: medium;">Preferred Qualifications</span></strong></div> <div><u><span style="font-family: Arial; font-size: medium;">Education:</span></u></div> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Bachelor&rsquo;s degree in Business Administration, Insurance, Criminology or a related field or the equivalent in related work experience</span></li> <li><span style="font-family: Arial; font-size: medium;">Completion of The Institutes Associates In Claims (AIC), Chartered Property Casualty Underwriter (CPCU), or other insurance coursework</span></li> <li><span style="font-family: Arial; font-size: medium;">Fraud Claim Law Specialist Certification</span></li> <li><span style="font-family: Arial; font-size: medium;">Certified Insurance Fraud Investigator Certification</span></li> </ul> <div><u><span style="font-family: Arial; font-size: medium;">Experience:</span></u></div> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Work experience in both claims handling as well as fraud investigation.</span></li> </ul> <div><u><span style="font-family: Arial; font-size: medium;">Knowledge and Skills:</span></u></div> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Medical injury treatment and medical provider practices as they relate to automobile accidents</span></li> <li><span style="font-family: Arial; font-size: medium;">Vehicle construction, repair estimation, repair and body shop industry practices</span></li> <li><span style="font-family: Arial; font-size: medium;">Home construction, repair estimation, repair and contractor industry practices</span></li> </ul> <div><strong><span style="font-family: Arial; font-size: medium;">Work Environment</span></strong></div> <p><span style="font-family: Arial; font-size: medium;">Works in a temperature controlled office environment. &nbsp;Occasional exposure to road hazards and temperature extremes.</span></p> <div> <div> <div id="_com_1">&nbsp;</div> </div> </div> <div><span style="font-size: medium;"><strong><u><span style="font-family: Arial; font-size: medium;">Required Qualifications:</span></u></strong></span></div> <div><strong><u><span style="font-family: Arial; font-size: medium;">Education:</span></u></strong></div> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">College level coursework in Business Administration, Insurance, Criminology or a related field or the equivalent in related work experience.&nbsp; Bachelor&rsquo;s degree preferred.</span></li> <li><span style="font-family: Arial; font-size: medium;">Possession of a valid State Driver's License.</span></li> </ul> <div><strong><u><span style="font-family: Arial; font-size: medium;">Experience:</span></u></strong></div> <p><span style="font-family: Arial; font-size: medium;">Work experience including one of the following:</span></p> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Five years of experience as a claim representative handling Auto or Home personal lines property and casualty insurance claims.</span></li> <li><span style="font-family: Arial; font-size: medium;">Three years as an investigator in a claims special investigation unit that investigates fraud in personal lines property &amp; casualty claims</span></li> <li><span style="font-family: Arial; font-size: medium;">Five years in law enforcement in roles such as detective, auto theft investigator, or an arson investigator.</span></li> </ul> <p><span style="font-family: Arial; font-size: medium;">Knowledge of at least one of the following:</span></p> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Laws and regulations pertaining to insurance, claim handling, crime, and investigative activity</span></li> <li><span style="font-family: Arial; font-size: medium;">Auto and Home policy coverages, provisions, and eligibility and underwriting rules</span></li> <li><span style="font-family: Arial; font-size: medium;">Claim handling practices</span></li> <li><span style="font-family: Arial; font-size: medium;">Claim fraud scenarios and indicators</span></li> <li><span style="font-family: Arial; font-size: medium;">Fraud investigation techniques and practices</span></li> </ul> <div><span style="font-family: Arial; font-size: medium;">Ability to perform the following:</span></div> <ul type="disc"> <li><span style="font-family: Arial; font-size: medium;">Communicate effectively with others in a work environment and with the public (e.g. Police department, vendors, contractors, attorneys, other insurance carrier special investigation units)</span></li> <li><span style="font-family: Arial; font-size: medium;">Analyze policies and claims for relevant provisions and applicability to the claim facts</span></li> <li><span style="font-family: Arial; font-size: medium;">Investigate claims, define appropriate evidence and obtain supportive documentation</span></li> <li><span style="font-family: Arial; font-size: medium;">Maintain and continually expend expert knowledge on claim fraud scenarios and indicators</span></li> <li><span style="font-family: Arial; font-size: medium;">Engage and manage experts to complete specialized tasks</span></li> <li><span style="font-family: Arial; font-size: medium;">Impart fraud awareness training in a formal or informal setting to other aaa employees, community groups or related professional organizations</span></li> <li><span style="font-family: Arial; font-size: medium;">Function effectively and independently in a personal computer environment utilizing word processing, spreadsheet and software systems</span></li> <li><span style="font-family: Arial; font-size: medium;">Present effective and persuasive testimony in civil and criminal litigation on a regular basis</span></li> <li><span style="font-family: Arial; font-size: medium;">Prepare and present effective written reports (a written sample may be required at time of interview)</span></li> <li><span style="font-family: Arial; font-size: medium;">Process complex, time-sensitive data, and information from various sources</span></li> <li><span style="font-family: Arial; font-size: medium;">Complete multiple complex tasks in a timely fashion and under deadline pressure while working on multiple cases simultaneously</span></li> <li><span style="font-family: Arial; font-size: medium;">Safely operate a motor vehicle&nbsp;</span></li> </ul> <p><span style="font-family: Arial; font-size: medium;">The Auto Club Group offers a competitive compensation and benefits package including a base salary with performance based incentives; medical/dental/vision insurance, 401(k), generous time off, a complimentary AAA Membership and much more!</span></p> <p><span style="font-family: Arial; font-size: medium;">Important Note: The above statements describe the principal and essential functions, but not all functions that may be inherent in the job.&nbsp; This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements.&nbsp; Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.</span></p> <p><span style="font-family: Arial; font-size: medium;">The Auto Club Group, and all of its affiliated companies, is an equal opportunity/affirmative action employer.&nbsp; All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.</span></p>