SIU Investigator - Philadelphia, PA

Delta Group•Philadelphia, PA

133d•$30 - $40

About The Position

Delta Group is hiring an SIU Investigator in Philadelphia, Pennsylvania. The Special Investigation Unit investigates and identifies questionable and suspicious insurance claims for its partners, working 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 insurance lines, with a heavy emphasis on Workers’ Compensation claims. The investigator conducts and documents investigations, gathers and evaluates evidence, communicates results and recommendations, and maintains professional relationships with relevant agencies and industry personnel. The final job level and annual salary will be determined based on the candidate’s education, qualifications, knowledge, skills, ability, and experience, calibrated against relevant market data and internal team equity.

Requirements

Strong investigative skills.
Attention to detail.
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 for conducting insurance claims investigations.
Proficiency with computer software, including Word, Excel, Outlook, and Teams.

Nice To Haves

CFE or FCLS designation preferred.
5–10 years of experience in claims and SIU investigations preferred.

Responsibilities

Conduct timely investigations, including recorded statements and interviews with 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 appropriate investigative action plans.
Ensure evidence gathered is accurate, high quality, and timely, 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 needed, including accident reports, accident-scene reconstructions, witness statements, police reports, or expert opinions.
Provide recommendations and decisions concerning investigative efforts.
Conduct detailed database queries on SIU investigations and analyze and organize critical data to support 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, assisting them when needed or required.