Job Overview
Location
CA - Remote
Job Type
Full-time
Category
Software Engineering
Date Posted
June 25, 2026
Full Job Description
đź“‹ Description
- • Leads complex, large-scale investigations into organized fraud rings, provider fraud schemes (medical, legal, and ancillary services), and referral/kickback schemes across multiple insurance lines.
- • Identifies patterns of coordinated fraudulent activity across claims to detect systemic and enterprise-level fraud risks.
- • Independently manages multi-jurisdictional cases from inception to resolution, including evidence collection, witness interviews, and case documentation.
- • Conducts advanced interviews with claimants, witnesses, employers, medical providers, and legal representatives using specialized interrogation techniques.
- • Secures recorded statements, affidavits, and physical evidence to substantiate investigative findings and support legal proceedings.
- • Performs on-site investigations, clinic inspections, and coordinates surveillance activities as necessary for field-based assignments.
- • Interprets and synthesizes large volumes of data from claims systems, billing records, social media, and third-party databases to uncover fraud indicators.
- • Applies link analysis and data correlation techniques to identify anomalies, networks, and relationships indicative of fraudulent behavior.
- • Develops actionable intelligence packages for internal stakeholders and external enforcement agencies, including law enforcement and regulatory bodies.
- • Investigates provider fraud involving upcoding, billing irregularities, and treatment patterns inconsistent with injuries or medical necessity.
- • Collaborates with internal experts and external professionals to evaluate medical necessity, provider networks, and treatment validity.
- • Evaluates fraud referrals and determines appropriate investigative strategies based on risk assessment and fraud indicators.
- • Builds comprehensive case files with well-documented evidence, timelines, and investigative summaries that meet standards for regulatory reporting, civil litigation, and criminal prosecution.
- • Partners closely with district attorneys, law enforcement, regulatory agencies, and legal counsel to advance cases and support prosecution or civil recovery.
- • Presents investigative findings professionally in court settings and during case reviews for legal proceedings.
- • Maintains detailed knowledge of the Unfair Claims Practices Act, insurance regulations, and evidentiary standards for civil and criminal investigations.
- • Produces clear, concise, and defensible investigative reports covering all phases of the case lifecycle.
- • Maintains accurate and timely documentation in case management systems to ensure proper case progression and compliance.
- • Utilizes investigative case management software (e.g., Polonious or similar) and Microsoft Office/Outlook for daily operations.
- • Applies fundamental knowledge of claims management processes and insurance claims handling procedures.
- • Demonstrates strong critical thinking, attention to detail, independent judgment, and high-level written and verbal communication skills.
- • Possesses ability to analyze and interpret complex data sets and present findings effectively in legal and regulatory contexts.
🎯 Requirements
- • Bachelor’s degree in Criminal Justice, Business, Accounting, Information Systems, or closely related field (or equivalent combination of education and experience)
- • Minimum of 5 years’ related work experience in investigations and/or law enforcement
- • Valid Driver’s license
- • Private Investigator’s License or fraud-related certifications (CFE, CIFI) preferred
- • Experience with investigative case management software (e.g., Polonious or similar)
- • Knowledge of Unfair Claims Practices Act, insurance regulations, and civil/criminal investigation procedures
🏖️ Benefits
- • Competitive salary range of $78,678.61 - $132,686.15
- • Generous medical, dental, and vision insurance plans
- • 401(k) retirement plan with company match
- • Bonus potential for all positions
- • Paid Time Off
- • Paid holidays throughout the calendar year
- • Full support for continued learning and professional development
Skills & Technologies
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About ICW Group Insurance Companies
ICW Group is a leading provider of workers' compensation insurance, offering comprehensive solutions to businesses across the United States. With a strong focus on safety, claims management, and policyholder support, ICW Group aims to protect employers and their employees. They are committed to delivering exceptional service and innovative programs designed to reduce workplace injuries and control costs. Their expertise extends to various industries, providing tailored insurance products that meet specific needs. ICW Group emphasizes building lasting relationships with policyholders, agents, and partners through integrity, responsiveness, and a dedication to financial strength and stability. They strive to be a trusted advisor in the workers' compensation landscape.
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