Senior Claims Representative, SIU
About The Position
The Senior Claims Representative, SIU is responsible for detecting and investigating potentially fraudulent insurance activity, including complex medical and staged accident claims and application fraud. Investigative work includes in-person interviews, recorded statements, field work as needed, and coordination with industry fraud units, claim personnel, counsel, law enforcement, and regulatory agencies. The role prepares and presents impartial investigation results to management and may provide evidence and testimony in prosecutions. The individual may also conduct fraud awareness training and investigative research. This is a remote position. The company provides a computer, phone, and vehicle. Applicants must live in New Jersey, preferably in Middlesex or Monmouth County. The role may require assignments elsewhere in New York or New Jersey based on business needs.
Requirements
- Bachelor’s degree.
- At least 7 years of insurance industry experience, or 5 years of law enforcement experience involving investigation of insurance-related crimes.
- Valid driver’s license.
- Strong computer skills, including Microsoft Excel, Word, Access, and Outlook.
- Strong verbal and writing skills.
- Working knowledge of home and auto policies and claims.
- Understanding of underwriting and premium fraud investigations.
- Knowledge of medical terminology and treatment plans.
- Must live in New Jersey; Middlesex or Monmouth County is preferred.
Nice To Haves
- Bilingual in Spanish.
Responsibilities
- Prioritize and manage multiple tasks simultaneously, adjusting to fluctuating workloads.
- Analyze claim files and make decisions based on file documentation.
- Maintain a diary to meet status-reporting requirements for all investigations.
- Complete investigations that address all referral issues.
- Complete nine hours of formal training per year.
- Participate in fraud awareness training for company associates.
- Network with law enforcement and other investigators in the SIU industry.
- Adhere to privacy guidelines.
- Cover large geographic areas.
- Complete accurate monthly reports and submit them to the supervisor on time.
- Occasionally complete assignments in other parts of New York or New Jersey based on business needs.
- Conduct interviews and recorded statements, perform field work as needed, and coordinate investigations with relevant internal and external parties.
- Prepare and present impartial investigation reports to management; provide evidence and testimony when law enforcement pursues prosecution, as needed.
- Conduct fraud awareness training and/or investigative research, as needed.
Benefits
- Four weeks of accrued paid time off and nine paid national holidays per year.
- Medical, dental, and vision insurance options beginning on the first day.
- Annual 401(k) employer contribution.
- Professional development resources, including LinkedIn Learning and licensure assistance.
- Health and wellness program and fitness reimbursements.
- Paid family leave options, including paid parental leave.
- Tuition reimbursement.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
