Claims SIU Specialist

Jewelers Mutual Group • Neenah, WI

12d • Onsite

About The Position

This role is primarily responsible for identifying, investigating, and
adjudicating suspicious and fraudulent insurance claims. This position will work
to prevent fraud, protect company assets and ensure that legitimate claims are
processed fairly. The role involves analyzing claims, conducting interviews,
gathering evidence, and collaboration with other departments and law enforcement
when necessary. This role will include management of SIU vendors, evaluation of
field investigators, liaison with Jewelers Security Alliance, and facilitation
of annual SIU training and certification.

This role includes significant engagement with Claim Examiners, SIU vendors,
adjusters, attorneys, Personal Lines Underwriting, Commercial Lines
Underwriting, Asset protection, and JSA (Jewelers Security Alliance). The ideal
candidate will be able to work on site at our home office location.

Requirements

• Attention to detail, precise recordkeeping
• Team player
• Can build a strong relationship with agents and/or customers
• Ask questions and communicate clearly
• Contributes to exceptional customer experience
• Initiative to act without being prompted
• Sound decision making
• Organized, understands prioritization, and meets deadlines
• Financial and business acumen
• Ability to remain flexible
• Actively seeking professional development
• Embraces and leads change
• Prior P&C claims adjusting experience required. Must have knowledge of claims processes, practices, and coverage.
• Proficient in Guidewire, Microsoft suite applications including Word, Excel, Outlook, and PowerPoint.
• Prolonged periods sitting at a desk and working on a computer.
• Occasionally required to stand; walk; use hands to finger, handle, or touch objects or controls; and talk or hear.

Nice To Haves

• Bachelor’s degree preferred.
• 3-5 years of relevant SIU/fraud claims handling experience preferred.
• Professional insurance designations such as CPCU, SCLA, AIC and or a fraud designation preferred.

Responsibilities

• Adjust all suspected SIU/Fraud Personal Lines Claims. This may include field adjusting tasks.
• Manage weekly rescission meetings. Review claims to determine if more information is needed, create and send denial letters when PL Underwriting and Legal agree that the policy will be rescinded.
• Run all background checks for Personal and Commercial lines claims. Provide comprehensive reports to the assigned PL or CL claim examiner.
• Manage suspect jewelers and handle Personal Lines claims when these jewelers are assigned. This includes adding claims to the jeweler monitoring list, working with JIAP, Jewelers Solutions and Strategic partners teams to address concerns about a particular jeweler.
• Identify fraudulent appraisals and suspect appraisers.
• Manage relationships with ISO/Verisk, NICB, Skopenow, Lexis Nexis, Allied Universal. This includes working with these vendors system upgrades and integrations.
• Manage and report state fraud referrals for PL & CL Claims. Create a quarterly report that includes line of business, number of referrals, location of insureds, etc.
• Manage file requests from other carriers through NICB and Allied Universal for PL & CL Claims.
• Manage request of files for PL & CL Claims through NICB and Allied Universal.
• Manage and evaluate field vendors, including investigators and adjusters.
• Create an SIU process for managing and tracking SIU claims including jewelers that may be involved. This includes using data such as AI to identify potential fraud on part of the insured or jeweler. Use data and AI to identify potential fraud rings in Personal Lines claims.
• Work with Jewelers Security Alliance to report and investigate suspected fraud.
• Manage and facilitate yearly SIU training.
• Provide input on reports, data, and bordereaux’s to TPA Cover holder
• Other duties as assigned

Benefits

• Competitive Compensation & Benefits: Includes performance bonuses, generous paid time off, and a top-tier retirement program with 401(k) matching and additional company contributions.
• Collaborative Culture: Work alongside talented, passionate peers who value ownership and continuous learning.
• Community & Giving: Benefit from 50% charitable gift matching and paid volunteer time to support nonprofit causes
• Great Place to Work® Certified: Join a team recognized for an environment of innovation and growth.

What This Job Offers

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