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 while handling assignments of moderate complexity and collaborating with senior SIU personnel on higher-complexity matters as needed.

Evaluate referred claims to determine whether suspicious circumstances are present Conduct interviews, review documentation, and research internal and external data sources to develop a factual understanding of each case Maintain accurate and timely documentation of investigative findings Coordinate with claims personnel throughout the investigative process Complete regulatory compliance fraud referrals to state and federal agencies, as well as NICB, in accordance with applicable requirements Support investigative strategy development and coordinate with vendors when appropriate Contribute to departmental anti-fraud initiatives and ongoing improvement efforts Maintain consistent, professional communication with internal and external partners Manage multiple assignments while adhering to established guidelines, expectations, and timelines

Competencies: Knowledge of basic insurance principles pertaining to claims processes and procedures Knowledge of good faith claims practices Knowledge of investigative methods and applicable laws, rules, and regulations involving insurance fraud Knowledge of privacy regulations and compliance requirements Proficiency with MS Office products Ability to easily adapt to new or changing situations and priorities Ability to be flexible and multi-task Dedication 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 Strong work ethic with a positive attitude Excellent verbal and written communication skills

Qualifications: Minimum of 3 years of prior SIU experience with demonstrated proficiency in investigating multiline claims Experience in workers' compensation and/or auto claims

Education Requirement Bachelor's Degree is preferred Professional designations such as CIFI, FCLS, FCLA, or CFE are beneficial but not required

Location and Travel: Primary location Urbandale, IA. Additional locations: Irving, TX; Chesterfield, MO; Glen Allen, VA; Florida; Atlanta, GA; West Hartford, CT; Scottsdale, AZ; High Point, NC. Travel: Occasional travel may be needed.

Sponsorship not Offered for this Role