SIU Senior Consultant

CNA Insurance • San Diego, CA

6d • $72,000 - $141,000 • Hybrid

About The Position

Under minimal direction, the SIU Senior Consultant initiates and manages suspected provider fraud investigations involving highly complex matters in California. The role requires knowledge of complex fraud schemes and emerging trends, law enforcement processes and reporting requirements, and the ability to testify credibly when called upon. The investigator uses analytical skills and knowledge of California fraud schemes, state regulations, Business and Professions Codes, CPT codes, and other applicable investigative tools. Knowledge of Qui Tam litigation, lien consolidations, and other civil remedies is preferred. The role also provides advice, direction, and support to technical claim teams and counsel regarding detection, investigation, and litigation of suspected claims.

The position is hybrid and works from one of CNA’s California offices in Walnut Creek, Los Angeles, Brea, Irvine, or San Diego. The role typically reports to a Manager or Director.

The SIU Senior Consultant leads complex investigations, develops strategies, coordinates investigative and vendor activities, maintains case records, and recommends claim resolutions. The position also contributes to process improvements, training and mentoring, preparation of cases for outside agencies, and criminal or civil actions, including testifying on the company’s behalf. The employee is expected to stay current on insurance fraud laws, regulations, trends, and emerging issues.

Requirements

• Bachelor’s degree or equivalent professional experience.
• At least eight years of experience conducting or directing investigations in insurance fraud, law enforcement, civil or criminal litigation, or a similar field.
• Advanced knowledge of property and casualty claim handling practices.
• Superior or expert technical knowledge of investigation and fact-finding practices and techniques.
• Excellent interpersonal, oral, and written communication skills, including the ability to synthesize and communicate complex issues to all organizational levels.
• Ability to interact and collaborate with internal and external business partners, including outside agencies.
• Ability to work independently, exercise good judgment, make sound business decisions, and develop others.
• Strong organization, attention to detail, and time-management skills.
• Ability to analyze highly complex and ambiguous problems and develop and implement effective solutions.
• Proficiency with Microsoft Office applications and similar business software, and understanding of relational database information-querying techniques.
• Ability to lead change while valuing diverse opinions and ideas.
• Ability to implement proactive, long-term strategies in support of business objectives.
• Knowledge of complex fraud schemes, emerging trends, law enforcement processes and reporting requirements, and California fraud schemes and applicable state regulations, B&P Codes, CPT Codes, and investigative tools.
• Ability to testify credibly when called upon.

Nice To Haves

• Advanced degree.
• Professional certification or designation related to fraud investigations, such as CFE, CIFI, FCLS, FCLA, or similar.
• Strong knowledge of Qui Tam litigation, lien consolidations, and other civil remedies.

Responsibilities

• Lead detailed, thorough, and timely investigations of suspected claim fraud in accordance with Best Practice Guidelines, collaborating with insureds, claimants, witnesses, and experts.
• Develop and execute investigation strategies independently or with claim professionals, counsel, experts, insureds, and other stakeholders.
• Manage investigations independently and/or coordinate and oversee vendor service partner activities in the field.
• Maintain detailed, accurate, and timely case records and prepare comprehensive reports of investigative findings and conclusions.
• Recommend claim resolutions by presenting findings and proposing solutions for matters of moderate to complex scope.
• Identify opportunities for and participate in the design and implementation of process or procedural improvements.
• Develop and deliver fraud-awareness or regulatory-compliance training and mentor lower SIU staff.
• Lead or direct preparation of cases for presentation to outside agencies and pursuit of criminal or civil actions, including gathering and documenting data, organizing and summarizing facts, and testifying on the company’s behalf.
• Continuously develop insurance-fraud knowledge by keeping current on laws, regulations, trends, and emerging issues and participating in insurance fraud or related professional associations.
• Provide advice, direction, and support to technical claim teams and counsel on detecting, investigating, and litigating suspected claims.

Benefits

• Comprehensive and competitive benefits package intended to support employees’ and family members’ physical, financial, emotional, and social wellbeing.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior