Director, Special Investigations Unit (Remote)

Davies • Home, AL

4d • Remote

About The Position

Our Story Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors. What's in Store We are on the lookout for a Director of Special Investigations Unit (SIU) who will be responsible for managing the organization’s fraud detection, investigation, and prevention programs across claims operations. This role oversees investigative strategy, regulatory compliance, and operational performance of SIU teams to identify, investigate, and mitigate insurance fraud, waste, and abuse (FWA). The Director collaborates with claims leadership, legal, compliance, and external agencies to ensure investigations are conducted effectively while protecting the organization from financial and reputational risk.

Requirements

• 8–12+ years of insurance claims or fraud investigation experience.
• 5+ years leadership experience managing SIU or fraud investigation teams.
• Knowledge of insurance fraud statutes and regulatory compliance requirements.
• Experience leading complex fraud investigations and litigation support.

Nice To Haves

• Bachelor’s degree in Criminal Justice, Insurance, Risk Management, or related field preferred.
• Certified Fraud Examiner (CFE) preferred.
• Certified Insurance Fraud Investigator (CIFI) preferred.
• Prior law enforcement or investigative background preferred.
• Experience in workers’ compensation, casualty, or liability investigations preferred.

Responsibilities

• Develop and execute enterprise SIU strategy to detect, investigate, and prevent insurance fraud.
• Monitor emerging fraud schemes and industry trends to proactively strengthen detection capabilities.
• Lead and manage SIU investigators, SIU 1099s, Field Investigators, and vendors while establishing performance expectations and KPIs.
• Conduct regular performance reviews of the SIU staff ensuring quality service standards are being met.
• Direct investigations into suspected fraud across workers’ compensation, liability, property, casualty, and disability claims.
• Ensure investigations meet company quality standards, regulatory standards, and evidentiary requirements.
• Review investigation findings, reports, and approve referrals to law enforcement or regulatory bodies.
• Collaborate with legal teams on litigation support, depositions, and fraud prosecution efforts.
• Ensure compliance with state insurance fraud regulations, reporting requirements, and anti-fraud plans.
• Maintain policies, SOPs, and training programs aligned with regulatory guidelines and industry standards.
• Utilize predictive analytics, claims data mining, and external fraud databases (e.g., ISO, NICB).
• Identify high-risk claims trends and coordinate fraud prevention initiatives with claims leadership.
• Assist leadership as needed with implementing technology and automation to improve investigation efficiency and case outcomes.
• Partner with claims, underwriting, legal, compliance, and audit teams to identify fraud indicators.
• Maintain relationships with law enforcement, regulatory bodies, and industry fraud networks as needed.
• Represent the organization in fraud task forces, industry groups, and regulatory meetings as needed.

Benefits

• Medical, dental, and vision plans to support your health and that of your family
• A 401(k) plan with employer matching
• Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
• Paid holidays
• Life insurance and short‑term and long‑term disability coverage
• Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee’s primary work location.
• Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements.

What This Job Offers

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