SIU Desk Investigator

SIU Desk Investigator

Requirements

• Minimum of 3 years claim handling experience required.
• Solid understanding of SIU or relevant claim processes, practices and applicable laws and regulations.
• Consistent high level of performance and achievement over career span.
• Ability to lead without having formal authority and to work both independently and in a team environment.
• Ability to manage multiple priorities in a challenging and fast-paced environment.
• Strong analytical and research skills.
• Demonstrated fraud awareness and aptitude.
• Effective interviewing and communication skills (written and verbal).
• Proven ability to build strong partnerships across segments and function.

Responsibilities

• Review claim referrals to determine whether they are appropriate for additional investigation. This includes a detailed claim review and various background searches.
• Investigate suspected fraudulent claim activity on the part of insureds, claimants and industry related providers.
• Proactively review claims to identify red flags through database research and background information analysis to determine if further investigation is needed.
• Establish and liaison within the investigative community, including fraud bureaus, state prosecutors, law enforcement agencies, Workers Compensation commissions, National Insurance Crime Bureau. Cooperate closely with Internal Audit Department investigations when requested.
• Prepare and submit investigative summaries documenting all phases of the investigation to assist with the claim resolution.
• Mentoring new and current SIU Desk Investigators when needed.

Preferred Qualifications

• Workers’ Compensation claim experience preferred.
• SIU and/or law enforcement experience preferred.
• College degree with criminal justice emphasis preferred.