Director of SIU

Position Summary The Director, Special Investigations Unit provides enterprise leadership and strategic direction for the organization’s fraud prevention, detection, investigation, and reporting activities, as well as oversight of collections operations and payment plan administration. Establishes and oversees the anti-fraud strategy, investigative governance framework, regulatory compliance program, and fraud-risk priorities. This position advises executive leadership on emerging fraud trends and significant investigative matters; directs the Special Investigations Unit’s people, budget, systems, vendors, and performance; and ensures effective collaboration with Claims, Underwriting, Premium Audit, Finance, Marketing, Legal Services, law enforcement, regulators, and external partners. Maintains appropriate independence, confidentiality, consistency, and objectivity in investigative activities while ensuring SIU operations support the organization’s legal, regulatory, financial, and business objectives. Duties and Responsibilities Contributes to the achievement of established department goals and objectives; adheres to departmental policies, procedures, quality, and safety standards as applicable, and consistently exhibits Chesapeake’s Values and Behaviors. Provides strategic leadership for the Special Investigations Unit and aligns fraud prevention, detection, investigation, reporting activities, and collections with organizational goals, legal requirements, and Chesapeake’s Values and Behaviors. Owns the organization’s Anti-Fraud Plan and monitors filings, reporting, training, regulatory examinations, and compliance with applicable laws, regulations, and standards. Establishes investigative policies, governance standards, case acceptance criteria, escalation protocols, documentation requirements, quality controls, and performance expectations. Provides oversight of complex, sensitive, high-exposure, or high-profile investigations and significant referrals for civil litigation, criminal prosecution, recovery, restitution, collections, or regulatory action. Provides operational oversight of collections and payment plan administration, including policies, workflows, performance expectations, escalation practices, compliance, and reporting. Leverages reporting, data analytics, automation, and emerging technologies, identify trends, monitor workloads and critical tasks, evaluate performance, and support timely, informed decision-making. Advises executive leadership on material investigative matters, emerging fraud trends, organizational exposure, control weaknesses, and recommended legal, operational, financial, or risk-mitigation actions, as requested. Serves as the senior SIU liaison to internal business units and represents the organization with regulators, law enforcement, prosecutors, outside counsel, industry partners, and other external stakeholders. Leads cross-functional fraud prevention initiatives and ensures investigative findings and trend analysis with appropriate policy, process, training, system, or control improvements, as required. Establishes and maintains departmental goals and performance indicators, to evaluate investigative quality, timeliness, outcomes, compliance, collections and recovery results, financial impact, resource utilization, and stakeholder service. Directs the department’s budget, workforce plan, technology, case management, data analytics, vendor relationships, and investment priorities to support efficient, effective, and accountable operations. Leads, develops, and evaluates SIU management and professional staff; makes or recommends personnel decisions and establishes succession, professional development, accountability, and knowledge-sharing expectations. Participates, as requested, in audits, compliance reviews, regulatory examinations, enterprise initiatives, and executive-level projects related to investigations and fraud risk. Performs other duties and responsibilities as assigned. Knowledge, Skills and Abilities Comprehensive knowledge of insurance fraud, investigative methods, case management, evidence handling, litigation support, prosecution referrals, regulatory compliance, and anti-fraud program practices. Knowledge of insurance operations, including claims, underwriting, premium audit, agency relationships, financial controls, and related legal and regulatory considerations. Knowledge of collections operations, payment plan administration, recovery practices, financial controls, and related legal and regulatory considerations. Demonstrated ability to establish strategy, governance, policies, performance measures, and organizational priorities for a specialized professional function. Ability to exercise sound, independent judgment in complex, sensitive, confidential, high-risk, or high-exposure matters. Ability to use management reporting, data analytics, automation, and emerging technologies to monitor operations, identify trends and risks, improve processes, and communicate actionable insights. Strong leadership presence and the ability to communicate complex investigative, legal, regulatory, financial, and operational information clearly and objectively. Proven effective leadership, talent development, organizational design, change management, and team-building capabilities. Strong analytical and strategic thinking skills, including the ability to identify patterns, evaluate risk, assess control effectiveness, and recommend practical actions. Ability to build effective relationships and influence decisions across organizational levels and with regulators, law enforcement, counsel, vendors, and industry partners. Ability to manage budgets, vendors, competing priorities, and multiple complex matters while maintaining quality, timeliness, confidentiality, and regulatory compliance. Minimum Qualifications Bachelor’s degree in criminal justice, business administration, insurance, finance, accounting, risk management, or a related field, or an equivalent combination of education and relevant experience. Twelve (12) or more years of progressively responsible experience in insurance investigations, fraud prevention, claims, compliance, law enforcement, financial crimes, or a related field. Five (5) or more years of leadership experience, including responsibility for people, programs, budgets, vendors, and organizational results. Professional designation or certification such as Certified Fraud Examiner (CFE), Certified Insurance Fraud Investigator (CIFI), FCLS, FCLA, CPCU, CAMS, or another relevant insurance, fraud, compliance, or investigative credential, or ability to acquire same within six months of hire. Demonstrated experience leading complex or sensitive investigations and working with executive leadership, legal counsel, regulators, law enforcement, and external partners. Demonstrated experience developing strategy, policies, procedures, performance indicators, management reporting, and recommendations for organizational action. Effectively utilizes technologies and tools, including Microsoft 365 and claims management systems, to support productivity and operational effectiveness. Valid driver’s license with an acceptable driving record. Preferred Qualifications Master’s degree in business administration, criminal justice, risk management, accounting, insurance, or a related field. Management experience in an insurance carrier’s Special Investigations Unit or enterprise anti-fraud program. Experience managing matters involving civil litigation, criminal prosecution, regulatory referrals, recoveries, restitution, premium avoidance, or collections. Experience supporting insurance regulatory examinations and presenting material risks and strategic recommendations to executive leadership. Experience implementing or enhancing investigative case management technology, fraud analytics, predictive tools, or enterprise fraud-awareness programs. Bilingual skills encouraged. Physical Demands This job description is intended to describe the general nature and level of work being performed. It is not an exhaustive list of all responsibilities, duties, and skills required. Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the essential functions. While performing the duties of the job, the teammate is regularly required to sit; use hands and fingers; handle or feel objects, tools, or controls; and reach with hands and arms. The teammate is occasionally required to stand, walk, stoop, kneel, crouch, or crawl and may occasionally lift up to 30 pounds. Specific vision abilities required include close vision, peripheral vision, and the ability to adjust focus. When working in the office, the teammate must be able to work in an office environment where the noise level is moderate. The position may require occasional travel and work outside normal business hours to support significant investigations, regulatory matters, or organizational needs. #J-18808-Ljbffr Chesapeake-Employers