Senior Claims SIU Investigator

2 weeks ago


Toronto, Ontario, Canada Zurich Insurance Company Full time

The Opportunity

Zurich Canada is seeking a highly skilled Senior Claims SIU Investigator to join our team. As a key member of our Special Investigations Unit, you will be responsible for conducting complex investigations of suspect fraud, high exposure, and complex claims within an assigned geographic region or Line of Business.

Key Responsibilities

  • Conducts complex, sensitive, or high exposure investigations within assigned geography or Line Of Business in the local Business Unit, or outside normal geography/Line Of Business, as required.
  • Researches information and database searches, prepares surveillance assignments, assigns to vendor and reviews results with subsequent documentation.
  • Leads investigative team on the resolution of highly complex, sensitive, and/or suspect organized ring cases within geography.
  • Investigates all aspects of highly complex claims referred for investigation, including circumstances of loss, background of individuals/businesses and underwriting aspects.
  • Participates in department and Business Unit initiatives as directed.
  • Gathers information from various sources and interviews witnesses.
  • Maintains impeccable documentation, back up and files to support all aspects of the case.
  • Prepares and provides investigative reports to Claims, Management, Business Partners, Business Units and other required stakeholders.
  • Acquires and efficiently organizes the relevant evidence and information necessary to accurately assess whether or not there is a fraudulent aspect to individual claims or fraud ring/network claims.
  • Collaborates with external agencies to secure information and data which is relevant to individual investigations.
  • Conducts desk and field investigations including face to face interviews with customers, witnesses and other persons relevant to the investigation, obtaining formal written statements.
  • Adheres to local regulation and Zurich Claims governance requirements throughout the investigative process to ensure that all information and data is obtained within data protection rules and regulations.
  • Liaises closely with senior managers and claim handlers throughout the investigative process and ensuring that all stakeholders are immediately aware of any important issues that are identified.
  • Identifies promptly cases which need to be further escalated.

Requirements

  • Bachelor's Degree and 7 or more years of experience in the professional investigations involving other financial crimes or Insurance claims investigation with a law enforcement agency area OR High School Diploma or Equivalent and 9 or more years of experience in the professional investigations involving other financial crimes or Insurance claims investigation with a law enforcement agency area
  • In depth knowledge of claims process
  • In depth knowledge of regulations and statutes in the assigned territory
  • Microsoft Office skills

About Us

Zurich Canada is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We are committed to providing ongoing career development opportunities and fostering an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging.



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