Claims SIU Consultant

Builders Mutual • Remote, NC

1d • Remote

About The Position

At Builders Mutual, we believe in the power of teamwork to get the job done right. Every day, our team delivers comprehensive commercial insurance and trusted safety solutions to protect and advance the unique needs of the contractor community. Rooted in teamwork, inclusion, expertise, and community, we work together to serve better, achieve more, and build lasting impact.

This position will report to the Vice President of Claims and will support Builders Mutual’s Special Investigations Unit program by providing oversight of fraud identification, investigative strategy, vendor governance, quality assurance, regulatory compliance, and outcome tracking across all lines of business. This role will serve as the primary internal resource for SIU program direction, claims-side investigative governance, and fraud consultation to Underwriting. This remote role will allow you to do your best work from your home office, collaborating virtually with your team daily. You will travel to our Raleigh office for meetings and company events as needed (typically up to four times per year).

Requirements

• Bachelor's degree preferred and a minimum of five (5) years of relevant claims, SIU, or fraud-investigation experience, or an equivalent combination of education and experience.
• Demonstrated experience managing or governing a vendor relationship of meaningful scope and cost, including invoice auditing and performance evaluation.
• Working knowledge of insurance fraud statutes and SIU/antifraud regulatory frameworks, including the NAIC Insurance Fraud Prevention Model Act and related SIU Model Regulation.
• Demonstrated ability to build tracking methodologies and translate claims data into defensible, decision-ready reporting.
• Strong verbal and written communication skills, including the ability to train adjuster staff and consult effectively with Underwriting.
• Sound judgment, initiative, and the ability to operate independently as an individual contributor in establishing a new program function.

Nice To Haves

• Law Enforcement experience is a plus.

Responsibilities

• Serve as the single point of accountability for Builders Mutual’s fraud identification and handling strategy across Workers’ Compensation, General Liability, Commercial Auto, Builders Risk, Inland Marine, and Property lines.
• Set SIU program direction and priorities in partnership with Claims leadership and communicate program performance, trends, and recommendations to senior leadership.
• Identify cross-line fraud trends, referral patterns, and emerging investigative needs across the company’s operating footprint.
• Own and manage SIU vendor relationships, including referral quality review, invoice and cost auditing, service-level performance tracking, and periodic vendor evaluation.
• Design and maintain a quality assurance framework to review SIU referrals and investigative outcomes for consistency, thoroughness, and compliance with state reporting obligations.
• Establish and maintain referral outcome and savings-tracking methodology to support quarterly and annual ROI reporting.
• Build recurring reporting on referral volume, cost per referral, outcome type, line-of-business distribution, and other metrics needed to support budget planning and vendor negotiation.
• Serve as a consulting resource to Underwriting on front-end, premium, and new-market fraud indicators.
• Develop and deliver fraud-recognition training for claims adjusters and, as appropriate, underwriting staff.
• Create and maintain adjuster-facing referral guidance, job aids, and procedures to improve referral consistency and quality.
• Ensure state-specific SIU and antifraud-plan reporting obligations, mandatory referral procedures, and annual fraud reporting requirements are met across applicable operating states.
• Maintain current knowledge of SIU/antifraud requirements and support maintenance of a compliance matrix for the company’s multi-state footprint.

Benefits

• Competitive compensation and a performance bonus program
• 3 weeks of PTO to start, plus your birthday off
• A 37.5-hour workweek, with Fridays ending at 2:30 PM
• Professional development through Builders University
• Everyday Wins recognition with swag and extra time off
• 8 paid Volunteer Time Off (VTO) hours to give back
• Comprehensive benefits that support your wellbeing today and your future tomorrow

What This Job Offers

• Job Type: Full-time
• Career Level: Senior