Sr. SIU Investigator

Description

Work-From-Home

Comprehensive Benefits Package

• Medical, Dental, Life Insurance – effective on start date
• 401k
• Paid Time Off Program
• Company Paid Holidays
• And Much More!!!
  
  

Senior-Level SIU Investigator Needed for Premier Third-Party Administrator

Job Description:

Handle a caseload of pending investigative claims files that encompass various levels of complexity. Responsible for conducting and overseeing field investigations and supporting North American Risk Service's anti-fraud initiatives. Requires confirming facts of loss and coverage, investigation through outside field investigators and recorded statements, identifying potential fraud and appropriate use of authorized vendors. Also includes timely interaction with state law enforcement and department of insurance fraud personnel, clients, and vendors, as well as appropriately drafted state fraud referrals. Ability to attend conferences, client meetings, mentor other adjusters and assist management as requested. All file handling must be within state statutes, Client Claims Handling Guidelines and NARS Best Practices. Other miscellaneous duties as assigned, which may include travel.

Essential Duties and Responsibilities:

Coverage:

• Understand various policy coverages (homeowner, commercial residential, commercial, condominium, rental, auto, commercial auto, work comp, etc.)
  
  

Customer Service/Contact:

• Contact appropriate parties to obtain any needed information.
• Answer phones, check voice mail regularly, and return calls as needed.
• Assist with training/mentoring of Claims Adjusters.
• Assist management when required with projects or leadership as requested.
• Handle the various duties/responsibilities of the Unit Manager as delegated in his/her absence.
• Must be willing and able to attend virtual meetings.
• Must be able to work in a fast-paced environment with demonstrated ability to handle multiple, competing tasks and demands.
  
  

Investigation:

• Participate as necessary in the review of all theft, fire, and other suspicious claims.
• Verify facts of loss and pertinent claims facts such as employment, wages, or damages and establish disability with treating physicians as appropriate.
• Review referred claims to determine if SIU investigation is warranted.
• Assign claims to and manage SIU vendor assignments for surveillance, investigations, engineering, Examinations Under Oath, medical canvass.
• Interact with law enforcement and fire/rescue personnel in the investigation of questionable claims. Get police and fire reports, as necessary.
• Support adjusters in assigning and overseeing proper completion of investigative vendors, including assignment of engineering firms, as well as their proper preservation of evidence.
• Assist with SIU Annual, New Hire and Ongoing Training.
• Assist with SIU State Fraud Reports and Audit responses.
• Provide comprehensive SIU fraud referrals to the appropriate state and local law and insurance officials.
• Attend industry meetings and liaise with state fraud investigators and law enforcement as needed.
• Assist in maintaining and updating Anti-Fraud documentation as needed.
• Assist in tracking state requirements and communicating to the company.
• Work with other insurance companies and law enforcement in sharing privileged file materials
• Conduct desk investigations including recorded statements, background checks and social media, utilizing technology aids such as ISO, Accurint, and others.
• Ensure compliance personally and by our adjusters with NARS SIU and Claims Best Practices.
• Assist coworkers with daily activities as needed.
• Assist in oversight of low impact and other fraud claims and assist in direction of other adjusters in managing these claims.
• Adhere to all file handling standards, NARS Best Practices, Client standards, state statutes and requirements necessary to pass audits performed by regulatory agencies, carriers, and clients.
• Maintain strict confidentiality of client, company, and personnel information.
• Track industry state or regional fraud trends.
• Know the Team’s Clients and be able to confidently discuss their claims.
• Participate in development and implementation of training programs.
• Maintain knowledge of current industry developments, case law changes and best practices.
• Conduct licensing/ownership investigations on business entities/clinics/medical providers/contractors/plumbers/water mitigations vendors.
  
  

Qualification Requirements:

Education / Licensing:

• High School Diploma or equivalent required, 2-year degree or higher preferred.
• A minimum of 5-7 years applicable investigative (SIU) experience in Claims, law enforcement agency, or other investigative organization.
• Fraud Claim Law Specialist or Certified Insurance Fraud Investigator designation desirable
• The preferred candidate will have experience with the various forms of property policies (HO3, HO4, HO6, Dwelling etc.), and property and liability coverages.
• Fraud Claim Law Specialist or Certified Insurance Fraud Investigator designation highly desirable.
• Current adjusters' license is a plus, or plan to obtain the license.
• Valid driver’s license.