Senior SIU Investigator

Encova Insurance • PA

129d • $77,450 - $123,921

About The Position

Encova Insurance is seeking a Senior SIU Investigator. This role will be home-based but you must reside in Pennsylvania. This role will report to the Manager, Special Investigations. The SIU investigator is responsible for the review, acceptance, action planning, investigation and documentation of suspect claims. The SIU investigator is the subject matter expert on insurance fraud and communicates directly with all levels of claims personnel with regard to investigative strategies and conclusions. The SIU investigator is responsible for fraud recognition training for claims personnel and agents and provides administrative record keeping on suspicious claim fraud for management, law enforcement, and resolution specialists.

Requirements

• At least three years’ experience in law enforcement, SIU investigation, or claims supervision; or at least four years as a resolution specialist.
• Strong interviewing and investigative proficiency.
• Strong interpersonal skills and organizational and analytical skills.
• Strong case management, communication and presentation skills.
• Thorough understanding of claims processes and procedures.
• College degree or equivalent experience in insurance.
• Possess the professional designation of CIFI or attain within 1 year of becoming an SIU Senior Investigator.
• Possess or attain the professional designation of FCLA within 2 years of becoming an SIU Senior Investigator.

Nice To Haves

• Multi-line insurance background.

Responsibilities

• Review referred suspicious claims and identify the scope of investigation needed.
• Investigate assigned suspicious claims.
• Determine and interview all parties who are material to the investigation.
• Independently perform investigative fieldwork to verify information and/or investigative leads.
• Utilize appropriate databases, informational resources and public records to verify information and/or investigative leads.
• Assign and oversee investigative vendors necessary for a thorough investigation.
• Identify and communicate relevant coverage issues during the course of the investigation.
• Independently analyze data and facts to develop action plans and provide investigative conclusions.
• Prepare complete, detailed, and accurate narrative investigation reports.
• Assist in the mentoring, development and providing of technical direction to other SIU investigators.
• Develop and coordinate training for SIU investigators in all phases of the investigation process.
• Keep statistical data for transfer into SIU database.
• Assist with and participate in examinations under oath.
• Review investigative results with resolution specialists and leadership before the claim is resolved.
• Appear in court as a company representative when needed.
• Assist in development of SIU field investigation standards and procedures.
• Generate and submit fraud reports to insurance departments.

Benefits

• 401(k)
• wellness programs
• bonus incentive plans
• flexible schedules
• early close of the office every Friday

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees