SIU Commercial Lines Specialist - Full Time/Remote

Job Description

Job Description

Description:

Opportunity:

Command is seeking an experienced SIU Investigator to join our growing Operations department. The SIU Investigator will be an embedded role with our client and will conduct claim/ policy file evaluations to investigate and document suspected fraudulent activity related to insurance claims or policies, prepare SIU evaluation reports, updates, state mandated reporting forms and documented fraud referrals. In addition, this position will obtain, document, and organize evidence that is suitable for presentation in a court of law to establish the presence of material misrepresentations and educate claims staff regarding insurance fraud, red flags, and the SIU process.

The ideal applicant will have Commercial lines experience and must be familiar with the claims processes for multiple other lines of insurance business including workers’ compensation, general liability, automotive and property claims and be able to provide in service training, including annual anti-fraud training, to integral anti-fraud client staff.

Essential Duties and Responsibilities:

· Conduct in depth claim file reviews to determine if suspect activity on claim exists, make determination if claim needs to be reported to applicable state agency for compliance purposes, and make recommendations to client on further investigation that may be needed.

· Conduct verbal consultations with adjusters to discuss suspected fraudulent claim activity and assist in the identification of industry accepted red flags.

· Identify and articulate red flags, suspected fraudulent activity, material misrepresentations and other indicators of insurance fraud.

· Educate claims staff via in service training and verbal consultations to promote awareness of insurance fraud, industry accepted red flags, the SIU process, and investigative best practices.

· Make sound investigative recommendations to claims staff that will assist in the identification and investigation of insurance fraud and promote claims savings.

· Coordinate investigations of suspected fraudulent activity with Command investigators, case managers, 3rd party vendors and prosecuting authorities.

· Obtain, document and report statistical information related to suspected fraudulent activity, red flags, state mandated reporting, arrests, convictions, sentencing, restitution, and claims savings.

· Obtain supporting documentation including claim documents, releases, and other records.

· Document all investigative efforts and case related communication in SmartPartner, Command's case management system.

· Coordinate and liaison with federal, state and/or local law enforcement and Departments of Insurance when required and provide any requested documentation in a timely manner.

· Provide courtroom testimony.

· Must conduct business hours between 8:00am - 5:00pm (East Coast time zone).

Qualifications:

· Must have a broad understanding of multiple lines of insurance with a thorough understanding of both personnel and commercial lines of Property and Casualty preferred.

· Five (5) years of prior SIU experience or claim adjusting experience at either the carrier or TPA level or seven (7) years conducting complex insurance claims investigations or any combination of education and experience to demonstrate the competencies necessary to perform the essential job functions.

· Experience handling multi-claim/ ring related activity specific to Auto and GL claims.

· Must have in-depth knowledge of claim files handling investigations, settlement processes/ procedures, legal issues/ litigation processes as it relates to claims, Claims Best Practices and quality review procedures, and insurance industry operations including sales and underwriting functions.

· Must have a current or the ability to obtain a Private Investigator’s License.

Educational Qualifications:

· Associates or bachelor’s degree (B.S. / B.A. in Criminal Justice, Business, or related field) from two or four-year college / university or equivalent SIU experience.

Benefits:

· Medical, Dental, Vision plans.

· Life, LTD and STD paid by the employer.

· Paid Time Off and company paid holidays.

· Company 401k plan.

· Entirely remote position.

Requirements:

· Dedicated workspace at home

· Must be able to work a minimum of 40 hours per week