Senior Claims SIU Inside Investigator at Gore Mutual Insurance

Cambridge, Ontario, Canada -

Full Time

Start Date

Immediate

Expiry Date

12 Mar, 26

Salary

0.0

Posted On

12 Dec, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Insurance Fraud Investigations, Claims Handling, Analytical Skills, Interviewing, Statement Taking, Communication Skills, Fraud Detection, Investigation Techniques, Fraud Awareness Training, Pattern Identification, Loss Exposure Assessment, Report Preparation, Collaboration, Artificial Intelligence Tools, Customer Service, Stakeholder Engagement

Industry

Insurance

Description

Next Horizon is here. Fueled by investments in talent and technology, our bold strategy to transform is nearly complete. At Gore Mutual, we’ve always set ourselves apart as a modern mutual that does good. Now, we’re proudly building on that legacy to transform our company—and our industry—for the better. Our path forward sharpens our focus on business performance, driven by leading technology, innovation and an agile, high-performing culture. With Gore Mutual and Beneva announcing their intent to merge in 2026, we’ll be uniting two well-established, financially strong, and trusted brands to become the strongest mutual insurer in Canada, ensuring Canadians have purpose-driven insurance options for generations to come. Come join us. The Senior Claims SIU Inside Investigator plays a critical role in identifying and investigating potential insurance fraud. This position focuses on desk-based investigations that do not require fieldwork, or where fieldwork can be delegated to SIU field investigators or external vendors. What You’ll Do: Investigate suspected fraud involving clients, third-party claimants, and suppliers (e.g., auto body shops, medical treatment providers) using internal resources and SIU vendors. Develop initial investigation strategies and update them as needed throughout the lifecycle of each file. Review submitted documents for discrepancies and verify their accuracy. Conduct thorough, audio-recorded interviews and obtain statements from clients, witnesses, and other relevant parties. Coordinate and participate in examinations under oath when required. Identify fraud patterns, assess loss exposure, and recommend mitigation strategies. Perform key investigative tasks, such as obtaining official reports and consulting with experts for additional insights. Prepare comprehensive final reports and provide recommendations to the claims department regarding file disposition. Review and prioritize incoming SIU referrals based on incurred amounts, complexity, visibility, potential risk, and limitation dates. Assign cases within designated timeframes to appropriate SIU handlers. Assist in the design and delivery of customized fraud awareness, detection, investigation, and prevention training for specialized business lines, including Underwriting, Claims, and Business Development. Act as a subject matter expert on insurance fraud for internal teams, clients, and brokers on an ad hoc basis. Ensure all investigations are conducted professionally, proactively, and in good faith, with timely responses to customer and broker inquiries. Support industry-wide anti-fraud initiatives by attending training sessions, CASIU events, Equite committee meetings, and other relevant forums to stay current on fraud trends. Contribute to the review, implementation, and ongoing use of artificial intelligence tools for fraud detection, including validating outputs, tracking savings, and reporting results. What You’ll Need to Succeed: Minimum 3 years of experience in insurance fraud investigations. Minimum 3 years of experience in claims handling. College or University education. CIP, CFEI, or CFE are preferred. Demonstrated expertise in conducting fraud-related investigations. Strong knowledge of anti-fraud practices and investigative techniques. Excellent analytical skills to identify patterns, quantify exposure, and develop mitigation plans. Proficient interviewing and statement-taking abilities. Strong written and verbal communication skills for reporting, training, and stakeholder engagement. Familiarity with industry events, ongoing training, and AI tools for fraud detection. Location: Hybrid - We operate under a flexible hybrid work model designed to support collaboration, productivity, and work-life balance. This role is primarily based in Cambridge, Ontario, with an expectation of being on-site two days per week. #LI-HYB #INDHP Accessibility for applicants Gore Mutual Insurance Company is committed to providing accommodations for people with disabilities during all phases of the recruiting process, including the application process. If you require accommodation because of a disability, we will work with you to meet your needs. Contact us and a human resources representative will consult with you to determine an appropriate accommodation. Should you request an accommodation during the interview process, please notify your Talent Acquisition Consultant.

Responsibilities

The Senior Claims SIU Inside Investigator is responsible for identifying and investigating potential insurance fraud through desk-based investigations. This includes developing investigation strategies, conducting interviews, and preparing comprehensive reports for the claims department.