Job Description

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Multi-state commercial insurance carrier is seeking a Senior SIU Investigator. The SIU Senior Investigator reviews and investigates referrals to the SIU to identify suspicious indicators of potential fraud committed by claimants, insureds, agents, brokers, providers and attorneys and conducts investigations of varying complexity. This is a remote position and reports to the SIU Manager. The ideal candidate will have proficiency in investigating claims across multiple lines of business to include Workers Compensation.

Key Accountabilities/Deliverables:

• Evaluate SIU referrals to establish if there are suspicious elements present that might warrant a SIU investigation and prepare concise investigative plans of action.

• Review claims via analytics programs to establish if SIU involvement is warranted

• Submit assignments to vendors for various investigative tasks when warranted and manage those assignments while controlling costs.

• Obtain, evaluate, and act on information and documentation received and communicate effectively with the claims staff, other insurance carriers, and law enforcement organizations such as the NICB, Department of Insurance, etc.

• Conduct data analysis and utilize analytical tools to identify suspicious claims.

• Prepare and submit investigative reports detailing and documenting all phases of an investigation to assist in the resolution of the claim.

• Compile and submit referrals to the NICB, Departments of Insurance, and other law enforcement agencies as warranted, clearly summarizing the investigation, and detailing the suspected fraud

• The investigator must understand and exhibit appropriate investigative behaviors and methods while conducting investigations, including development of the facts, due diligence with evidence collection, and conducting interviews both recorded and non-recorded.

• Effective time management skills, proactive execution of investigative plans, and flexibility are necessary to ensure the effectiveness of this position.

Technical Knowledge and Understanding:

• Intermediate to Advanced Microsoft Office Skills/ multiple software applications, fluent with multiple investigative computer programs such as TLO, ISO, Accurint, etc.

• Excellent oral, written, and interpersonal communication skills are required

• Must be customer service oriented, highly organized and efficient

• Detailed-oriented with the ability to work in a team environment and be flexible to daily changing needs and job duties.

• Ability to analyze and solve problems, working closely with others to coordinate and complete projects

• Spanish / multiple language skills are preferred

Experience:

• Bachelor’s degree is preferred

• Minimum of 3 years of SIU-related experience for an insurance company and/or law enforcement investigative experience, or an equivalent combination of education and experience, is required

• Experience in conducting Workers Compensation claims / SIU investigations is preferred

• Industry-related professional designations such as FCLS, FCLA, and/or CIFI are preferred

Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa for this position. 

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At Core Specialty, you will receive a competitive salary and opportunities for professional development and advancement. We offer medical, dental, vision, and life insurances; short and long-term disability; a Company-match of 100% of a 6% contribution 401(k) plan; an Employee Assistance Plan; Health Savings Account, Flexible Spending Account, Health Reimbursement Account, and a wellness program

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