Manager, Special Investigations & Recovery

Position Summary

The Manager, Special Investigations & Recovery is responsible for overseeing the company’s fraud detection, subrogation, and recovery functions. This role coordinates all potential fraud investigations and ensures compliance with state-level SIU reporting requirements. Using traditional and AI-based fraud detection indicators and other investigative tools, the Manager partners with adjusters and claims managers to evaluate concerns, determine appropriate investigative strategies, and assign cases to third-party vendors. The position plays a key role in safeguarding the company’s financial interests, optimizing fraud detection processes, supporting the fair and accurate assessment of claims, and enhancing subrogation and recovery outcomes.

Key Responsibilities

• Serves as the central coordinator of all potential fraud investigations across the claims department and as primary liaison for third-party fraud vendors and subrogation and recovery vendors.

• Interprets fraud detection indicators and investigative tools, include AI-based indicators providing human analysis and decision-making to determine next steps.

• Reviews and interprets claims data and data from third-party vendors in order to make recommendations for improvements in investigations, processes and outcomes.

• Using ISO data and predictive models to proactively conduct and/or facilitate additional investigation on claims.  

• Partners with adjusters and claims managers to assess claim legitimacy and develop investigation strategies.

• Assigns investigative fieldwork to third-party vendors and oversees vendor performance, quality, and compliance.

• Completes and/or contributes state-level SIU statistical reporting functions in conjunction with compliance department personnel.

• Provides consultative support to claims staff regarding fraud detection, subrogation, and recovery opportunities.

• Reviews vendor investigative findings and prepares or validates reports summarizing conclusions and recommendations.

• Coordinates with legal, compliance, underwriting, and law enforcement/regulatory agencies when necessary.

• Develops and facilitates training and awareness initiatives to strengthen fraud prevention capabilities across the claims team.

• Seeks out new vendors with insightful data sources and technology solutions that help identify fraud or questionable claim indicators.

• Performs other duties as assigned.

Qualifications

• 10+ years of commercial insurance claims experience, including direct handling of litigation caseloads; 3+ years of leadership experience preferred.

• Strong background in claims handling, fraud detection, and subrogation with proven ability to evaluate complex claims.

• Strong knowledge of Claims investigation laws and regulations.

• Bachelor’s degree (or equivalent experience).

• Demonstrated proficiency in current fraud analytics, technology and investigative tools (e.g., ISO, Carpe Data, or similar).

• Knowledge of SIU regulatory requirements and state-level statistical reporting obligations.

• Experience managing or coordinating third-party investigative vendors.

• Excellent analytical, critical thinking, and problem-solving skills.

• Strong communication and collaboration skills, including ability to influence decision-making across claims teams.

Compensation & Benefits

The applicable base salary for this opportunity is $100,000 - $120,000. The base pay offered will be determined by factors such as experience, skills, training, location, certifications, education, and any applicable minimum wage requirements. In addition to the base salary, this opportunity may be eligible for performance-based incentives.​  We are excited to offer a competitive total rewards package which includes health and welfare benefits, tuition and professional certification assistance, 401k savings, elective participation in the Employee Stock Purchase Program, paid time off, paid holidays, and child bonding leave, as well as other employee assistance.

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