Claims Investigator

Job Description

Job Description

SIU Consultant Group is a full-service investigation firm delivering high-quality investigative solutions to employers, insurance carriers, public entities, third-party administrators, and legal counsel. Backed by more than 25 years of industry experience, the firm utilizes proven processes that consistently exceed industry standards. SIU Consultant Group is committed to providing exceptional service, achieving measurable cost savings, and delivering reliable, results-driven outcomes for its clients.

The Claims Investigator is responsible for examining insurance claims to determine their validity and ensure that all aspects of a claim comply with company policies, legal standards, and regulatory requirements. This role involves gathering evidence, interviewing involved parties, analyzing documentation, and identifying potential fraud. The ideal candidate is detail-oriented, analytical, and capable of making objective decisions based on facts.

Responsibilities

• Conduct thorough investigations of insurance claims, including property, casualty, health, or workers’ compensation claims.
• Review claim files, policy details, and supporting documentation to assess accuracy and legitimacy.
• Interview claimants, witnesses, medical professionals, and other relevant parties.
• Collect and analyze evidence such as police reports, medical records, photographs, and surveillance data.
• Identify inconsistencies or indicators of fraudulent activity.
• Prepare detailed reports summarizing findings, conclusions, and recommendations.
• Collaborate with legal teams, adjusters, and law enforcement when necessary.
• Maintain compliance with federal, state, and company regulations and guidelines.
• Testify in court or legal proceedings as needed.

Requirements

• Bachelor’s degree in Criminal Justice, Insurance, Business Administration, or a related field (or equivalent experience).
• Proven experience in investigations, insurance claims, law enforcement, or a related role.
• Strong analytical, problem-solving, and critical-thinking skills.
• Excellent written and verbal communication abilities.
• Ability to handle sensitive and confidential information with integrity.
• Proficiency in investigative tools, databases, and reporting software.
• Knowledge of insurance policies, legal procedures, and fraud detection techniques.
• Valid driver’s license and willingness to travel as required.