Insurance Fraud Investigator SIU - Orlando Florida

United Auto Insurance•Orlando, FL

2d•Remote

About The Position

United Automobile Insurance Company (UAIC), a large, family-owned property and casualty insurance company, is seeking an Insurance Fraud Investigator (SIU) to join their team. This is a remote position, requiring the candidate to be located in the Orlando, Florida area. The role involves conducting field and desk investigations to detect fraud in complex claims, including staged auto accidents, fraud rings, and questionable medical treatments, primarily for non-standard auto liability policies. The investigator will provide expertise to limit exposure and protect company assets, utilizing methods such as database searches, Examinations Under Oath, and scene canvasses. A strong focus on thoroughness, quality, timeliness, and cost control is expected. The position requires preparing and submitting detailed SIU investigative reports, maintaining contact with various internal and external stakeholders, and investigating alleged Fraud, Waste, and Abuse by medical providers, body shops, and others.

Requirements

Associate or bachelor’s degree in a related field preferred and/or 5 years of related work experience.
Bilingual (English & Spanish)
Knowledge of current procedural terminology.
Strong critical thinking and analytical skills with the ability to interpret data and trends.
In-depth knowledge of applicable fraud statutes, regulations, and industry best practices.
High degree of integrity as demonstrated by appropriate treatment 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 a keen eye for detail.
Detail-oriented investigator with strong organizational and time management abilities
Analytical and interview skills: ability to make deductions; logical and sequential thinker.
Computer literate; database and Internet proficient. Has knowledge of available resources (internal and external) to assist in investigations.
Ability to work with others in a team environment.

Nice To Haves

Expert knowledge of medical claims processing and investigations, a strong plus.
Experience in CPT codes and medical terminology is highly preferred.

Responsibilities

Conduct clinic inspections and examinations under oath.
Conduct in-depth research and review of suspected fraudulent or abusive patterns to develop sufficient evidence to conclusively establish facts involving insureds, claimants, medical and auto body shop providers, or other entities.
Collect, utilize, and interpret data from a variety of computer-generated reports and other sources; thereby identifying and documenting questionable patterns related to medical modalities, procedures, and other practices which merit further investigation.
Maintains assigned investigation files, documents evidence, and prepares comprehensive investigation reports at the completion of each investigation.
Assist in conducting comprehensive interviews: medical and other providers aforementioned, insureds/claimants in the presence of their attorneys where applicable, and witnesses to obtain statements and information admissible under accepted rules of evidence in civil and criminal court proceedings.
Conducts special projects initiatives/investigations referred by the House Counsel.
Establishes and maintains liaison with NICB, Law Enforcement officers, and others to obtain assistance in conducting, facilitating, and enhancing investigations.
Knowledgeable about all applicable insurance regulations, especially PIP regulations to ensure duties and assignments are carried out within the requirements of applicable law and office expectations.
Mentor and teach less experienced investigators, promoting teamwork and collaboration among the department. Encourage sharing of insights, experiences, and best practices within the SIU team.