Special Investigative Unit (SIU) Specialist
Job description
Under general supervision and with independent judgment, conducts comprehensive claims investigations to detect or deter fraudulent activity, makes recommendations and offers guidance to claims leadership and staff on claims resolution for all lines of business, and maintains compliance with legal and industry standards, by performing the following duties:
Essential Duties and Responsibilities:
1. Conducts comprehensive investigations of questionable insurance claims and policies suspected of insurance fraud, including:
a. Communicates with insureds, claimants, witnesses and others to gather facts of the loss; Maintains contact during the course of investigations with all stakeholders involved in claim
b. Conducts thorough searches using investigative databases, internal resources, Internet resources, and public records to locate parties and collect evidence to determine if potential fraud exists.
c. Conducts scene investigations and interviews; obtains detailed recorded statements from all involved parties
d. Analyzes and documents results of investigations to determine course of action; makes recommendation to appropriate claims staff.
e. Ensures investigation reporting is compliant with applicable fraud statutes
f. Makes requests, prepares documents and assists with examinations under oath; may testify in court proceedings
2. Conducts risk analysis to forecast and minimize potential exposures, such as medical provider fraud, inflated billing schemes, organized ring activity, etc.
3. Develops and maintains rapport and cooperation with federal, state and local government agencies, as well as private information bureaus that can assist in investigative efforts.
4. Assists with the development and training of claims staff in the detection of claims fraud.
5. Serves as a liason with industry SIU groups and vendors to deter known and emerging trends in claims fraud.
6. Serves as a contributing member of project team(s), or leader of project team(s), coordinating resources to ensure achievement of project activities
7. May provide leadership to junior staff by training and providing guidance. May provide input to management regarding junior staff performance.
8. Performs other duties as assigned
Required Skills
Required Experience
- Four to six years related experience and/or training; or bachelor's degree (B.A.) from four-year college/university; or equivalent combination of education and related experience/training.
- A minimum requirement for this position is the ability to work legally in the United States. No visa sponsorship/support is available for this position, including for any type of U.S. permanent residency (green card) process.
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