Key Responsibilities:

Case Intake & Triage:

Review alerts, referrals, and claims for indicators of fraud or suspicious activity, including misrepresentation, forgery, beneficiary fraud, and agent/distributor misconduct. Independently prioritize and triage the SIU's cases based on risk, severity, exposure, regulatory deadlines and reputational risk. Establish and maintain accurate, audit-ready case logs and documentation standards in accordance with internal procedures and regulatory guidelines. Manage a concurrent caseload of complex, high-value investigations from intake through resolution, often serving as escalation point for cases initiated by other team members. Interpersonal and presentation skills to communicate, and represent the SIU, with internal and external sources Comfort operating in a small or scaling team, including contributing to process design and program build-out rather than relying solely on existing infrastructure.

Investigation Conduct & Leadership:

Lead and independently manage end-to-end fraud investigations involving life insurance claims, policy procurement, and distribution channel activity, including multi-jurisdictional or organized fraud schemes. Serve as lead case strategist on all of SIU's complex investigations, coordinating cross-functional response among claims, compliance, underwriting, and legal as well as external investigators or vendors Plan and conduct structured interviews of claimants, agents, witnesses, and other relevant parties, including high-stakes or adversarial interviews requiring advanced interviewing strategy. Gather, organize, and critically analyze evidence sets including claim records, policy files, medical records, financial statements, public records, and third-party data sources. Compile and organize investigative exhibits, evidence packages, and case files suitable for internal review, civil referral, criminal referral, or regulatory submission. Draft clear, concise, and well-supported fraud case summaries and investigative reports for SIU leadership, legal counsel, and compliance teams as well as reports to state departments of insurance and national fraud databases within required timeframes. Help define investigative standards, case documentation templates, and onboarding practices.

Regulatory Compliance:

Ensure all SIU activities are conducted in accordance with state and federal insurance fraud regulations. Lead preparations and submission of mandatory fraud reports to state departments of insurance and national fraud databases (e.g., NICB). Maintain documentation for audits and regulatory reviews. Monitor and interpret regulatory changes, emerging fraud schemes, and industry trends, translating implications into updated investigative practice for the team

Data & Reporting:

Apply advanced data mining and analytics techniques to detect emerging fraud patterns and surface new risk indicators. Track and report key case metrics including volumes, investigation outcomes, cycle times, and estimated fraud savings. Develop and present fraud trend analyses and reporting for senior leadership Partner with internal and external detection/analytics personnel to refine fraud detection models based on casework findings.

Training & Awareness:

Design and deliver fraud awareness training and educational materials for staff, agents, and distribution partners. Monitor industry developments and proactively share insights to strengthen fraud prevention efforts. Act as a subject-matter resource for less experienced investigators and other departments on fraud indicators and investigative best practice.

Qualifications:

Bachelor's degree in Criminal Justice, Business, Insurance, or a related field. 5-8 years of experience in insurance claims, fraud investigations, insurance audit or compliance (life insurance experience strongly preferred), minimum 5 years investigative experience. Demonstrated expertise in life insurance products, policy structures, claims adjudication processes, fraud typologies, and investigative methods specific to life insurance. Proven ability to independently plan and conduct structured investigative interviews, including complex or adversarial interviews, with strong written communication skills and a demonstrated track record of producing investigative reports and case summaries used in regulatory or legal proceedings. Demonstrated ability to manage concurrent investigative caseload of complex investigations with minimal oversight. Ability to interpret life insurance policy documentation and analyze policy lifecycle activity, transactions, and claim information across multiple systems to identify inconsistencies, anomalies, or indicators of fraud.

Preferred Qualifications:

Experience with anti-fraud tools and data analytics platforms. Familiarity with state SIU regulations and reporting platforms (e.g., NAIC, NICB). Experience identifying red flags related to life insurance-specific fraud schemes Prior experience liaising directly with law enforcement or regulatory agencies on referred cases. Familiarity with AML (anti-money laundering) programs or cross-functional fraud/AML collaboration Experience evaluating or implementing third-party anti-fraud data/technology vendors.

Skills:

Advanced analytical, organizational, investigative, critical thinking and communication skills (verbal & written). Proficiency in Microsoft Office and investigation or claims management systems. Organized, methodical approach to evidence compilation and file management Ability to work collaboratively across departments and with external parties, including law enforcement and regulators. Licenses +

Certifications:

Certified Insurance Fraud Investigator (CIFI), Certified Fraud Examiner (CFE), FLMI (Fellow, Life Management Institute), or related designation is strongly preferred.

Compensation & Benefits:

We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide:

Salary:

$91,545 - $118,470

Medical Insurance:

Choose from a variety of plans to fit your healthcare needs.

Dental Insurance:

Coverage for preventive, basic, and major dental services.

Employer-Paid Vision :

Comprehensive eye care coverage at no cost to you.

Employer-Paid Basic Life and AD&D Insurance:

Peace of mind and additional protection.

Employer-Paid Short-Term and Long-Term Disability Insurance:

Financial support in case of illness or injury. 401(k)

Plan:

Save for your future with a company match to help you grow your retirement savings. PTO and Sick Time accrue each pay period: Take time off when you need it

Annual Bonus Program:

Performance-based bonus to reward your hard work.

EEOC/Other:

eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages. Remote work is not available in the following

States:

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