Auto Insurance Fraud Investigator - South Florida

United Auto Insurance•Miami, FL

8d•Remote

About The Position

United Automobile Insurance Company (UAIC) is seeking an Insurance Fraud Investigator (SIU) for a remote position. The investigator must be located in the South Florida area, specifically Miami-Dade or Broward County. The role conducts field and desk investigations of high-complexity claims involving staged auto accidents, fraud rings, and questionable medical treatment, with the goal of limiting exposure and protecting company assets. Investigations cover private passenger and commercial auto liability claims for non-standard policies and may include database searches, Examinations Under Oath, and scene canvasses. The investigator is expected to emphasize thoroughness, quality, timeliness, and cost control; prepare SIU investigative reports covering each phase of assigned cases; and maintain contact with supervisors, internal legal professionals, external medical professionals, government and regulatory agencies, NICB, law enforcement, and vendors. The role also investigates alleged fraud, waste, and abuse by medical providers, body shops, and other entities.

Requirements

Bilingual in English and Spanish.
Knowledge of current procedural terminology.
Strong critical-thinking and analytical skills, including the ability to interpret data and trends.
In-depth knowledge of applicable fraud statutes, regulations, and industry best practices.
High degree of integrity, including appropriate handling of confidential information and adherence to policies, rules, and regulations.
Effective communication and interpersonal skills, with the ability to build and maintain relationships with internal and external stakeholders.
Excellent organizational and project-management abilities, with attention to detail.
Strong organizational and time-management abilities.
Analytical and interviewing skills, including the ability to make deductions and think logically and sequentially.
Computer literacy and proficiency with databases and the Internet; knowledge of internal and external resources that can assist investigations.
Ability to work with others in a team environment.
Associate or bachelor's degree in a related field preferred and/or five years of related work experience.

Nice To Haves

Expert knowledge of medical claims processing and investigations.
Experience with CPT codes and medical terminology.

Responsibilities

Conduct clinic inspections and Examinations Under Oath.
Research and review suspected fraudulent or abusive patterns in depth, developing evidence and establishing facts involving insureds, claimants, medical providers, auto body shops, or other entities.
Collect, use, and interpret computer-generated reports and other information sources to identify and document questionable patterns involving medical modalities, procedures, and other practices.
Maintain assigned investigation files, document evidence, and prepare comprehensive reports upon completion of each investigation.
Conduct interviews with providers, insureds, claimants, and witnesses to obtain statements and information admissible in civil and criminal court proceedings; interview insureds or claimants in the presence of their attorneys when applicable.
Conduct special projects and investigations referred by House Counsel.
Establish and maintain liaison with NICB, law enforcement officers, and others to assist, facilitate, and enhance investigations.
Apply applicable insurance regulations, especially PIP regulations, when carrying out duties and assignments.
Mentor and teach less experienced investigators and promote teamwork, collaboration, and sharing of insights and best practices within the SIU team.
Investigate alleged fraud, waste, and abuse by medical providers, body shops, and other entities.