SIU Investigator – Desk

SIU Investigator – Desk

Requirements

• High School Diploma or General Equivalency Diploma.
• 2 years claims adjusting experience, or P&C SIU/Fraud Investigation experience OR 4 years prior investigative law enforcement (to include military) or relevant fraud industry investigation experience.
• Proven investigatory skills.
• Experience obtaining statements from various parties to incidents, witnesses, and suspects.
• Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.
• Proven ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems.
• Familiarity with using computers and various software packages to enter and extract data for analysis from relevant data sources and systems.
• Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.

Responsibilities

• Apply knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third part claims.
• Participate in the development of fraud prevention strategies.
• Apply knowledge of P&C insurance industry products, services, and processes in investigating claims to include P&C insurance policy contracts, coverages and internal claims handling process and procedures.
• Apply knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
• Collect evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.
• Make recommendations within defined authority guidelines.
• Prepare and presents detailed and comprehensive verbal and written investigative reports summarizing the results of the investigation and recommended outcome.
• Develop and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.
• May serve as a resource team member on specific matters through demonstrated skill or training.
• Assist with the delivery of fraud awareness training initiatives in a defined environment.
• Handle CAT duty responsibilities as business requires.
• Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

Preferred Qualifications

• SIU Desk experience
• P&C experience to include Auto, Property and Underwriting
• Current or prior SIU investigations experience working in diverse teams across multiple functions within SIU