SIU Investigator

SIU Investigator

Summary:

Responsibility includes conducting thorough investigations to validate meritorious claims, while aggressively defending against fraud. The Investigator will perform telephonic and field investigations regarding auto insurance claims referred to and accepted for investigation by the Special Investigative Unit.

As one of our Special Investigators, you may be expected to create and conduct training for fraud awareness for the claim staff. You may also create and file state fraud plans, conduct state specific training and ensure annual SIU activity is reported.

Reporting Relationship:

This individual will report to the SIU Manager

Essential Duties and Responsibilities:

To perform this role successfully, an individual must be able to meet each of the following essential duties and responsibilities:

• Knowledge of the principles of casualty insurance and the auto casualty claims adjustment process
• Ability to review claim files and identify fraudulent red flags and/or trends
• Ability to formulate and execute a full investigation alongside the claims adjuster on suspicious claims involving fraud or inflated claims
• Obtain detailed recorded statements via phone or in person with loss participants
• Proven knowledge of investigative and interview techniques
• Requests and reviews medical records and billing to validate injuries and accuracy of services provided
• Conducting and/or directing Examinations Under Oath
• Utilize insurance investigative databases, internet resources and public records to locate parties and collect evidence
• Obtain required documentation from involved parties in accordance with state regulations
• Coordinate investigations with outside SIU contacts, Vendors, the Department of Insurance Fraud Division, NICB, and various law enforcement agencies
• Ability to communicate effectively both written and verbal with both internal and external parties
• Assigns and manages outside vendors when necessary
• Must demonstrate a thorough knowledge of underwriting practices; assist UW in reviewing and investigating underwriting issues, consumer fraud and company exposures
• Attends any pertinent SIU training to maintain and develop investigative skills applicable for level of position
• Conduct SIU training to claim staff
• Completes field work as required in South Florida
• Must be able to complete the investigations within the mandated period required by either state and/or federal contracts and/or regulations.
• Must be able to work under deadlines and multitask
• Ability to juggle multiple cases at once, maintaining work quality and turnaround time while communicating effectively with SIU manager
• Document all SIU investigations thoroughly and in a manner compliant with various state departments of insurance and other law enforcement agencies.
• Able to work independently with minimum supervision
• Report all required claim activity to DOI
• Participates in roundtable meetings

Qualifications:

• Knowledge of bodily injury and property damage claims terminologies and processes
• Minimum of three years of auto insurance carrier special investigations experience
• Ability to communicate effectively both written and verbal with both internal and external parties
• Working knowledge of Microsoft office applications
• Organizational and multi-tasking abilities
• Strong analytical skills to effectively investigate suspected insurance fraud
• Completion of the NICB Basic and/or Advanced Academies is desirable
• Fraud Claims Law Specialist (FCLS) or Fraud Claims Law Associate (FCLA) designations and Certified Insurance Fraud Investigator (CIFI) or Certified Fraud Examiner (CFE) designations are preferred
• Solid computer skills and use of MS Office Products

Education and Experience:
Associates or Bachelor’s degree in Criminal Justice or a related field or equivalent

Job Requirements:

The above job description is not intended to be an all-inclusive list of duties and standards of the position

Knowledge & Experience

5 years of special investigation experience is required.

Knowledge of PIP claims handling, as well as medical clinic investigations, is required.

Embark General Insurance Agency, LLC delivers property and casualty insurance programs through a network of independent insurance producers. Embark provides an enhanced customer experience by offering a streamlined, accurate, user-friendly process to drive the greatest value for the customer. Embark will offer various insurance products in multiple states over the next few years. The company’s management team averages over 25 years of insurance experience in producing profitable books of business and is backed by strong carrier and reinsurance partners.

Embark General Insurance Agency, LLC is an exciting, high-growth carrier in the property and casualty insurance industry. Embark General Insurance Agency, LLC offers competitive compensation and great benefits. We have a high-energy work environment filled with terrific people. No phone calls please. EOE