SIU Major Case Consultant

SIU Major Case Consultant

Requirements

• Must have at least 5 years of Major Case experience.
• Minimum of bachelor’s degree required.

Responsibilities

• Apply appropriate investigative techniques & strategies pertaining to large scale and organized fraud schemes, ensuring cases are conducted following laws pertaining to insurance claims, mandated reporting and good-faith investigative practices.
• Proactively develop and lead investigations involving multifaceted allegations and/or significant financial exposure across multiple claims and lines of business.
• Utilize critical thinking techniques and advanced analytical skills to synthesize and summarize intricate case findings.
• Clearly communicate and present investigative outcomes and case briefs to both internal and external stakeholders.
• Maintain a strong working knowledge of national legal and regulatory environments relevant to insurance fraud.
• Collaborate with internal stakeholders with appropriate anti-fraud deterrence and affirmative litigation strategies.
• Deliver testimony and present case results in legal or regulatory proceedings.
• Travel nationally to support investigations, foster cross-functional relationships, and engage with government agencies and industry professionals.
• Identify and address workflow inefficiencies while promoting a culture of continuous improvement.
• Monitor and forecast emerging fraud trends and vulnerabilities, sharing insights with internal stakeholders.
• Serves as the subject matter expert on medical and non-medical fraud to business and industry partners.
• Deliver training on fraud issues and investigative techniques.
• Lead or contribute to special projects and perform other duties as assigned.

Preferred Qualifications

• Demonstrated leadership abilities & aptitude.
• Consistent high level of performance and achievement over career span.