SIU Desk Investigator - Miami

AssuranceAmerica•Miami, FL

3d•Onsite

About The Position

The SIU Desk Investigator assists the Special Investigations Unit and claims departments with suspected insurance fraud. The role conducts low- to moderate-complexity investigations involving insurance applications, auto and property claims, and injury claims. It plans, prioritizes, and carries out investigative assignments, including background research, interviews, and Examinations Under Oath, and analytically reviews suspicious claims using investigative methods and techniques. The investigator evaluates relevant information to resolve suspicious and complex investigations and applies legal and claims principles, with a working understanding of coverage and/or personal injury protection coverage. This is an in-office position. Only candidates residing in Miami-Dade County will be considered, and relocation assistance is not available. The primary responsibility is conducting Examinations Under Oath and reporting the findings. The position also provides office training on recognizing potentially suspicious or fraudulent files, maintains compliance with industry and company policies, and keeps current with regulatory and statutory requirements and changes in law. Employment is at-will, and the job description's duties are not all-inclusive.

Requirements

Bachelor's degree in criminal justice, finance, business administration, or a related field.
At least 2 years of prior SIU investigator or claims-handling experience.
Working understanding of coverage and the requirements of personal auto policies and/or personal injury protection coverage.
Florida Insurance Adjusters License required within 90 days of employment.
Excellent communication and interpersonal skills, including the ability to interact effectively with diverse stakeholders.
Attention to detail and ability to maintain confidentiality when handling sensitive information.
Proficiency in relevant software applications for data analysis and documentation.
Knowledge of insurance laws, regulations, and industry standards related to fraud investigation.
Ability to manage multiple cases and prioritize tasks.
Effective problem-solving, interviewing, organizational, and time-management skills.
Strong verbal and written communication skills.
Ability to work collaboratively and maintain ethical conduct.

Nice To Haves

Previous experience in insurance claims investigation, fraud detection, or law enforcement.
Knowledge of medical terminology, medical billing, and CMS 1500 forms.
Customer service orientation, adaptability, and commitment to continuous learning.

Responsibilities

Conduct Examinations Under Oath and report the findings.
Investigate claims, including taking statements and analyzing and verifying documents and damages.
Provide office training to help staff recognize potentially suspicious or fraudulent files.
Ensure compliance with industry and company policies.
Understand regulatory and statutory requirements and maintain knowledge of changes in state and national law.
Properly use claims and other company systems.
Attend industry meetings to identify industry trends.
Complete an individual weekly Investigator report for the manager.
Attend and participate in team meetings and roundtables.
Maintain professional contacts in SIU, claims, law enforcement, legal, and related fields to keep investigative methods and procedures current.
Meet individual goals and objectives.
Maintain consistent, fair, and diplomatic interactions with co-workers.
Perform other duties as assigned by the SIU Manager.