SIU Senior Investigator

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Requirements:

• Bachelor’s degree in business, insurance, criminal justice or related field or equivalent relevant experience
• Five years of claims adjusting, investigation or insurance experience or related experience
• Prior property and casualty experience preferred
• Fraud Claim Law Specialist (FCLS) designation within the first year of hire
• Insurance designations, such as INS or AIC, preferred
• Strong knowledge of the investigative process, including proper identification and collection of physical evidence
• Strong knowledge of civil and criminal investigative procedures and the legal system
• Strong knowledge of various statement taking techniques, collection and analysis of public and private records
• Good knowledge of property and casualty insurance industry and fraud awareness preferred
• Strong investigative skills and ability to make sound decisions
• Good conflict resolution, negotiation and facilitation abilities
• Ability to work independently and as part of a team
• Strong verbal and written communication skills, including file documentation and report writing
• Good knowledge of computers and Microsoft Office Suite
• Attendance of the National Insurance Crime Bureau SIU Academy within the first two years of hire
• Occasional travel; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving

Responsibilities:

• Promptly investigates and evaluates SIU referrals of moderate to high complexity, including organized ring activity
• Reviews claim, underwriting and premium audit files pertinent to the referral
• Initiates contact with other departments, insureds, claimants, witnesses, vendors, other carriers, attorneys, law enforcement or any others to obtain information
• Researches background information, including public records, claims history and social media sites
• Takes statements from insureds, claimants, witnesses and other pertinent parties.
• Documents all special investigative handling and activity
• Reviews the facts of an investigation and completes field investigations
• Attends examinations under oath (EUOs) and depositions for assigned cases
• Secures and reviews bills, invoices, receipts and other documentation for legitimacy and accuracy
• Tracks trends and patterns of investigations regarding organized ring activity
• Provides status updates on special investigations to branch or corporate office team members, agents, defense counsel and law enforcement entities
• Identifies, investigates and pursues opportunities for recovery or restitution
• Develops and evaluates investigative data and evidence to formulate recommendations
• Conducts analysis of all investigative materials to formulate a recommendation for further handling, including payment, compromise or denial of a claim or rescission of a policy
• Prepares a special report with written summaries of all investigative data
• Communicates with branch and corporate office departments, as well as other impacted entities, regarding investigative activities and evidence to support or exonerate potential fraud
• Prepares documentation in compliance with a state’s anti-fraud reporting requirements on each investigation
• Prepares evidence packets related to civil litigation or criminal prosecution for submission to defense counsel, National Insurance Crime Bureau (NICB), State Fraud Bureaus and/or Attorney General’s offices or other law enforcement entities
• Develops assigned internal and external anti-fraud training and marketing of SIU services
• Develops assigned internal and external anti-fraud training
• Provides anti-fraud training to internal and external customers through investigative discussions and dissemination of educational materials
• Collaborates with team members in developing marketing strategies for the SIU department and its services
• Implements assigned marketing strategies
• Participates in the establishment of effective policy standards, practices, techniques and procedures for the investigation, evaluation and disposition of the SIU referral. Maintains active involvement in professional associations within the industry.