Auto Insurance Fraud Investigator SIU - Houston, Texas

United Auto Insurance•Houston, TX

11d•Remote

About The Position

United Automobile Insurance Company (UAIC) is seeking an Insurance Fraud Investigator (SIU) to investigate high-complexity auto insurance claims involving staged accidents, fraud rings, questionable medical treatment, and alleged fraud, waste, or abuse by medical providers, auto body shops, and other entities. The role includes both field and desk investigations involving private passenger and commercial auto liability claims for non-standard policies. Investigative methods may include database searches, examinations under oath, clinic inspections, and scene canvasses. The position focuses on thoroughness, quality, timeliness, and cost control while helping limit exposure and protect company assets. The investigator maintains case files, documents evidence, and prepares comprehensive reports for review. The role involves researching suspected fraudulent or abusive patterns, analyzing data and computer-generated reports, interviewing relevant parties, and coordinating with internal and external stakeholders, including legal professionals, medical professionals, government and regulatory agencies, NICB, law enforcement, and vendors. The investigator also handles special projects referred by House Counsel and mentors less experienced investigators. This is a remote position, and the employee must be located in Houston, Texas.

Requirements

Bilingual in English and Spanish.
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 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 stakeholder relationships.
Excellent organizational and project-management abilities with attention to detail.
Detail-oriented, with strong organizational and time-management abilities.
Analytical and interview 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 investigative resources.
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

Associate or bachelor's degree in a related field.
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 to develop evidence and establish facts involving insureds, claimants, providers, or other entities.
Collect, use, and interpret computer-generated reports and other data to identify and document questionable medical modalities, procedures, and practices.
Maintain investigation files, document evidence, and prepare comprehensive reports upon completion of investigations.
Assist with interviews of medical and other providers, insureds, claimants, and witnesses to obtain statements and information admissible in civil or criminal proceedings.
Conduct special projects and investigations referred by House Counsel.
Establish and maintain relationships with NICB, law enforcement officers, and others to support and enhance investigations.
Apply knowledge of applicable insurance regulations, particularly PIP regulations, when carrying out assignments.
Mentor and teach less experienced investigators and promote teamwork, collaboration, and sharing of best practices within the SIU team.