Desk Investigator - Counter Fraud
HybridBishops Cleeve, England, United Kingdom or The Grange, State of Queensland, Commonwealth of Australia
Job Summary
Conduct end-to-end investigations into suspected insurance claims fraud, including policy application fraud, exaggerated loss, and non-disclosure. Gather and evaluate evidence from multiple sources, including claim files, databases, and open-source intelligence, while obtaining evidential statements and maintaining auditable case records. Make balanced recommendations on claim repudiation, settlement, or escalation to civil or criminal action, and prepare structured reports to support claims decisions and legal proceedings. Contribute to fraud trend analysis, develop indicators and profiles, and share insights with Claims and Fraud teams to improve detection strategies. Liaise with external parties such as law enforcement and insurers, ensuring all activities comply with relevant legislation and regulatory requirements.
Required Qualifications
- Proven experience in insurance claims fraud investigation or a related investigative role
- Strong understanding of insurance claims processes and common fraud typologies
- Excellent investigative, analytical, and critical‐thinking skills
- Ability to assess evidence objectively and make defensible recommendations
- Strong written and verbal communication skills, including report writing and interviewing
- Conversation management interviews
- Obtaining evidential witness statements
- High level of integrity and attention to detail
- Ability to manage a caseload effectively and meet deadlines
- Use of using fraud detection tools, intelligence systems or data analytics
- Knowledge of industry databases and information- sharing arrangements
- Intelligence gathering and reports working to National Intelligence Model (NIM)
- Degree or equivalent
- Professional qualifications or certification e.g. CII, CILA, ACFS
Desired Qualifications
- Ethics, integrity, and professionalism
- Strategic leadership and commercial acumen
- Technical authority and judgement
- Risk management and quality assurance
- Client focus and stakeholder confidence
- People leadership and talent development
- Driving value for money and sustainable growth
- Attention to detail
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