Investigator II – Special Investigations Unit ( Tennessee, North Carolina, Kentucky, Virginia )

Job Summary

Join us at West Bend, where we believe that our associates are our greatest asset. We hire talented individuals who are conscientious, dedicated, customer focused, and able to build lasting relationships. We create and maintain an environment where you feel a sense of belonging and appreciation. Your diversity of thought, experience, and knowledge are valued. We’re committed to fostering a welcoming culture, offering you opportunities for meaningful work and professional growth. More than a workplace, we celebrate our successes and take pride in serving our communities.

Responsibilities & Qualifications

• Investigate suspected insurance fraud involving auto, property, casualty, workers’ compensation, and other personal, commercial, and specialty lines of business.
• Collaborate with internal stakeholders and external partners to evaluate and investigate suspicious insurance transactions (claims, underwriting, policy, etc.), collect evidence, support fraud detection programs, and communicate investigative findings to internal and external partners, regulators, and law enforcement.
• Support fraud detection and investigation by identifying red flags, gathering facts, and documenting evidence in compliance with company policy and legal requirements.
• Review claim files for basic red flags (inconsistencies, late reporting, coverage anomalies, questionable damages, medical billing issues).
• Apply checklists, referral criteria, and scoring tools to determine whether further investigation is warranted.
• Conduct thorough investigations of suspect insurance claims on moderate to high complexity cases with minimal supervision.
• Evaluate, coordinate, and recommend investigative action plans in collaboration with claims, underwriting, and legal partners.
• Cook up and monitor outside vendor activity related to assigned SIU investigations.
• Prepare detailed investigative reports for internal decision-making; support referrals to law enforcement or legal action when necessary, and where applicable to state fraud bureaus.
• Stay informed on regulations and statutes as well as internal protocols and procedures.
• Maintain thorough documentation of investigative actions and work products in accordance with accepted SIU operating standards and best practices.
• Serve as a subject matter expert for claims and/or Underwriting Department training on the detection, deterrence, and prevention of fraud.

Preferred Experience And Skills

• 6-8 years of fraud investigation, claims investigation, SIU support, or related research/analyst experience or equivalent combination of education and experience.
• Well-developed skills in evidence gathering and interviewing with demonstrated ability to follow investigative processes and best practices are essential.
• Clear written and verbal communication skills, including the ability to summarize complex findings; collaborative mindset and commitment to continuous learning as tools, regulations, and fraud tactics evolve.
• Proficient with investigative databases and standard office software.
• Ability to proficiently use computers and software for data entry, digital tools for research, and investigative analysis; digital photo/video documentation of loss scenes and evidence.
• Ability to work effectively with AI-enabled investigative tools (e.g., fraud scoring, anomaly detection, entity/link analysis, and automated summarization) while applying sound judgment and documenting the rationale for decisions (human-in-the-loop).
• Analytical and problem-solving Skills.
• Interpersonal Skills.
• Knowledge of fire cause and origin.

Salary Statement

The salary range for this position is $ 68,000-$90,000 . The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, business needs, geographical location, and internal equity. Compensation decisions are made by West Bend and are dependent upon the facts and circumstances of each position and candidate.

Benefits

• Medical & Prescription Insurance
• Health Savings Account
• Dental Insurance
• Vision Insurance
• Short and Long Term Disability
• Flexible Spending Accounts
• Life and Accidental Death & Disability
• Accident and Critical Illness Insurance
• Employee Assistance Program
• 401(k) Plan with Company Match
• Pet Insurance
• Paid Time Off
• Enhanced PTO may be available for experienced candidates
• Bonus eligible based on performance

EEO

We provide equal employment opportunities to all associates and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.