Claims Fraud Detection Specialist - Mid-Level (VA, WV, TN) (MORGANTOWN)

Why USAA?

Read all the information about this opportunity carefully, then use the application button below to send your CV and application.

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values honesty, integrity, loyalty and service define how we treat each other and our members. Be part of what truly makes us special and impactful.

The Opportunity

We are looking for a SIU Investigator (mid-level). This is a desk position. Within defined guidelines and framework, protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance with state insurance fraud-related laws and regulations and policies and procedures.

This role is remote eligible. However, you must currently live in the covered territory, which is Virginia or West Virginia or Tennessee . There may be occasional business travel.

What you'll do :

Applies knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third part claims.

Participates in the development of fraud prevention strategies.

Applies knowledge of P&C insurance industry products, services, and processes in investigating claims to include P&C insurance policy contracts, coverages and internal claims handling process and procedures.

Applies knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.

Collects evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.

Makes recommendations within defined authority guidelines.

Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results of the investigation and recommended outcome.

Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.

May serve as a resource team member on specific matters through demonstrated skill or training.

Assists with the delivery of fraud awareness training initiatives in a defined environment.

Handles CAT duty responsibilities as business requires.

Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

What you have :

High School Diploma or General Equivalency Diploma (GED).

2+ years claims adjusting experience, or P&C SIU / Fraud Investigation experience OR 4+ years prior investigative law enforcement (to include military) or relevant fraud industry investigation experience.

Proven investigatory skills.

Experience obtaining statements from various parties to incidents, witnesses, and suspects.

Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.

Demonstrated ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems.

Familiarity with using computers and various software packages to enter and extract data for analysis from relevant data sources and systems.

Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.

What sets you apart :

SIU experience conducting low to complex PNC fraud investigations OR a combination of Claims and Law Enforcement Investigations OR Military Investigative experience.

Designations such as CFE, CIFI, SCLA, ACLS, FCLS, LPCS, AIC, CPCU, CCLS, or other.

US military experience through military service or a military spouse / domestic partner

Compensation range : The annualized range for this position is : $77,120 - $147,390. However, this is an hourly position.

Compensation : USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

Benefits : At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on

Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.

USAA is an Equal Opportunity Employer. xklufbp All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.