SIU Investigator

Are you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hire innovative people who consistently adapt, grow and deliver. We believe in hard work, a fun work environment, and embracing creativity that only comes about when talented people collaborate to develop solutions. Our mission is to create the best insurance experience possible.

Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for seven consecutive years as a Top 50 performing P&C company offering the stability of a large, profitable and growing company combined with a small-company entrepreneurial spirit. Our purpose-driven ethos provides team members with opportunities to contribute, develop, and belong.

PURPOSE OF THE JOB

The purpose of this job is to detect, prevent, and investigate suspected fraudulent claims for all lines of insurance, with heavy emphasis on Workers’ Compensation claims. This position exists in order to protect company assets and deter insurance fraud.

Essential Duties And Responsibilities

Detects and investigates suspected fraudulent claims.

• Analyzes, organizes, and investigates multi-line types of fraud investigation.
• Evaluates all referrals for fraud and ensures essential data is located and documented.
• Ensures investigative results are acted upon and measures ROI of same.
• Conducts investigations with a focus on thoroughness, quality, with attention to detail, timeliness and cost control.
• Maintains a systematic and effective method to detect and investigate suspected fraudulent claims and provide for their appropriate disposition.
• Locates, extracts, analyzes, and organizes critical data from multiple systems to prevent and detect fraud.
• Ensures the accuracy, quality, and timeliness of the evidence gathered.
• Understands applicable laws, legal codes, court procedures, precedents, government regulations, executive orders, and agency rules for effective investigations.
• Prepares and submits timely investigative reports covering all phases of the investigation.
• Utilizes prescribed case management system (Polonious) to document the detection, investigation and tracking of suspected fraudulent claims, actively moving them towards their appropriate disposition.
  
  

Manages relationships and keep consistent communication with multiple departments and outside agencies.

• Prepares and presents completed investigations to appropriate senior staff and/or criminal justice personnel in a highly professional and timely manner.
• Maintains contact during the course of investigations with Claim Examiners, Risk Management, Auditors, Hearing Reps, Marketing, Underwriting, Claimants, Policyholders, Agents, Brokers, SIU, Legal and Medical Professionals, Government/Regulatory Agencies, Law Enforcement and Vendors.
• Facilitates effective communications with regulatory and enforcement agencies.
• Coordinates vendors to ensure appropriate outcomes and efficient pricing.
  
  

Helps deter future insurance fraud through training others and keeping abreast on industry research.

• Assists with the development and training of the claim, underwriting, and integral anti-fraud staff in the detection of external and/or internal fraud.
• Educates and trains Claim Examiners, Underwriters and integral insurance personnel to identify possible insurance fraud by red flag events.
• Utilizes multiple online resources to deter and defeat fraud.
  
  

Supervisory Responsibilities

This role does not have supervisory responsibilities.

Education And Experience

Bachelor's degree from four-year college or university preferred with a major or emphasis in Criminal Justice or related field; or equivalent combination of education and experience required. Associates Degree in Criminal Justice preferred. Minimum 4 years of related insurance claim experience required; or equivalent combination of education and experience.

CERTIFICATES, LICENSES, REGISTRATIONS

Private Investigator's License, fraud related certificates (CFE, CIFI) recommended but not necessary, given proper background experience in fraud investigation.

Knowledge And Skills

Working knowledge of insurance and claim operations, commercial, personal, and Worker’s Compensation insurance products, and vendor management. Ability to read, analyze, and interpret the most complex documents. Ability to respond effectively to the most sensitive inquiries or complaints. Ability to write speeches and articles using original or innovative techniques or style. Ability to communicate while in meetings, presentations or legal proceedings. Ability to make effective and persuasive presentations on controversial or complex topics to law enforcement or others. Candidates must be proficient in the use of a personal computer, including MS Word, MS Excel, MS Outlook and be able to learn various proprietary computer applications. Ability to define problems, collect data, establish facts, and draw valid conclusions.

Physical Requirements

Office environment – no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.

WORK ENVIRONMENT

This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment.

The current range for this position is

$68,481.25 - $115,489.01

This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.

WHY JOIN ICW GROUP?

• Challenging work and the ability to make a difference
• You will have a voice and feel a sense of belonging
• We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
• Bonus potential for all positions
• Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year)
• 11 paid holidays throughout the calendar year
• Want to continue learning? We’ll support you 100%
  
  

ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.