Senior Claims SIU Inside Investigator

Next Horizon is here. Fueled by investments in talent and technology our bold strategy to transform is nearly complete.

At Gore Mutual weve always set ourselves apart as a modern mutual that does good. Now were proudly building on that legacy to transform our companyand our industryfor 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 well 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.

TheSenior Claims SIU Inside Investigatorplays 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 Youll 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 Youll Need to Succeed:

• Minimum3 years of experiencein insurance fraud investigations.
• Minimum3 years of experiencein 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.

The expected base salary range for this position is $56000 - $103500. Depending on your relevant experience skills qualifications market conditions and business needs base compensation may vary. You have the potential to earn more through Gore Mutuals discretionary bonus program which gives you an opportunity to increase your total compensation provided the business meets its performance targets and you meet your individual goals.

Please note: This rangereflects the expected base salary for this role but may not represent the full compensation range for all experience and skill levels. During the recruitment process we will discuss and consider how your unique qualifications align with the broader range for this position.

Gore Mutual is proud to offer a comprehensive total rewards package which includes extended health and dental benefits disability insurance retirement plan matching paid time off recognition and perk programs.

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This posting pertains to an existing vacancy that is actively being filled.

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 usand 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.