SIU Investigator

Siu Investigator The SIU Investigator is responsible for conducting timely investigations into claims where indicators of potential fraud, misrepresentation, or suspicious activity exist. This role supports the organization's anti-fraud objectives by gathering facts, evaluating information, and contributing to proper claim outcomes. The SIU Investigator handles assignments of moderate complexity and collaborates with senior SIU personnel on higher-complexity matters as needed. Key Functions/Duties of Position: Evaluates referred claims to determine whether suspicious circumstances are present. Conducts interviews, reviews documentation, and researches internal and external data sources to develop a factual understanding of each case. Maintains accurate and timely documentation of investigative findings. Coordinates with claims personnel throughout the investigative process. Completes regulatory compliance fraud referrals to state and federal agencies, as well as NICB, in accordance with applicable requirements. Supports investigative strategy development and coordinates with vendors when appropriate. Contributes to departmental anti-fraud initiatives and ongoing improvement efforts. Maintains consistent, professional communication with internal and external partners. Manage multiple assignments while adhering to established guidelines, expectations, and timelines. Education Requirement: Bachelor's Degree is preferred. Professional designations such as CIFI, FCLS, FCLA, or CFE are beneficial but not required. Qualifications: The position requires a minimum of 3 years of prior SIU experience with demonstrated proficiency in investigating multiline claims. Experience in workers' compensation and/or auto claims is essential. Exhibit knowledge of basic insurance principles pertaining to claims processes and procedures Knowledge of good faith claims practices Demonstrate knowledge of investigative methods in regards to laws, rules and regulations involving insurance fraud Knowledge of privacy regulations and compliance requirements Proficiency with MS Office products Easily adapts to new or changing situations and priorities Ability to be flexible and multi-task Dedicated to meeting the expectations of internal and external customers Strong organizational and prioritization skills Ability to properly handle sensitive and confidential information Ability to work both independently and in a team environment Demonstrate a strong work ethic with a positive attitude Excellent verbal and written communication skills #J-18808-Ljbffr W.R. Berkley