SIU Investigator - Philadelphia, PA

Delta Group•Philadelphia, PA

27d

About The Position

Delta Group is hiring an SIU Investigator in Philadelphia, Pennsylvania. The Special Investigation Unit investigates and identifies questionable and suspicious claims for its partners, communicating with claims personnel, insurance carrier SIU staff, law enforcement, and government regulatory agencies to identify, prevent, and deter fraud. The role calls for extensive experience with claims across all lines of insurance, with a heavy emphasis on Workers’ Compensation claims. The investigator conducts and documents investigations, gathers and assesses evidence, keeps case managers and clients informed, and provides findings and recommendations to claim adjusters. The position also involves database research and analysis, evaluating state compliance referrals when applicable, and maintaining professional relationships with law enforcement, regulatory agencies, and insurance industry personnel. Delta Group is a privately held national investigative firm established in 1983 and headquartered in Buford, Georgia, with more than 500 direct employees nationwide.

Requirements

Strong investigative skills.
Detail-oriented approach.
Ability to recognize patterns of inconsistencies that may be linked to fraudulent activity.
Ability to interact with clients, repair shops, appraisers, and employers.
Ability to work independently.
Excellent verbal and written communication skills.
Good organization and time-management skills.
Knowledge of tools and techniques used to conduct insurance claims investigations.
Proficiency with computer software, including Word, Excel, Outlook, and Teams.
Ability to use an objective perspective when performing tasks.
Five to ten years of experience in claims and SIU investigations is preferred.
Extensive claims experience across all lines of insurance, especially Workers’ Compensation, is sought.

Nice To Haves

CFE or FCLS designation preferred.
Five to ten years of experience in claims and SIU investigations preferred.

Responsibilities

Conduct timely investigations, including recorded statements and interviews of claimants, witnesses, and employers.
Provide timely status updates to the case manager and client.
Document claim files clearly and promptly.
Maintain confidentiality and professionalism.
Develop an appropriate investigative action plan.
Ensure the accuracy, quality, and timeliness of evidence gathered and comply with applicable laws, legal codes, and governing agencies.
Provide claim adjusters with timely investigation results and document investigative findings.
Determine whether additional evidence is required, such as accident reports, accident-scene reconstructions, witness statements, police reports, or expert opinions.
Provide recommendations and decisions regarding investigative efforts.
Perform detailed database queries on SIU investigations and analyze and organize critical data to support assigned investigations.
Evaluate state compliance referrals, as applicable, when questionable or suspicious activity is identified.
Maintain active membership in professional organizations that provide SIU assistance and resources.
Establish and maintain relationships with law enforcement, government regulatory agencies, and insurance industry personnel, and assist them when needed or required.