SIU Senior Investigator

EMC Insurance Companies•Iowa - Work From Home, IA

5d•$75,911 - $119,646•Remote

About The Position

The SIU Senior Investigator investigates and evaluates moderate- to high-complexity Special Investigation Unit referrals, including organized ring activity. The role reviews relevant claim, underwriting, and premium audit files; gathers information from internal and external parties; researches background information; takes statements; conducts and documents investigations; and attends examinations under oath and depositions. The investigator analyzes evidence and investigative materials to recommend further claim or policy handling, including payment, compromise, denial, or rescission. The position also supports recovery and restitution efforts, prepares investigative reports and anti-fraud and litigation documentation, and communicates findings to relevant business partners and law enforcement entities. The role tracks organized-ring trends, contributes to anti-fraud training and SIU marketing, implements assigned marketing strategies, and participates in establishing effective investigation and disposition standards and procedures. The position is eligible to work from home anywhere in the United States and requires occasional travel. A valid driver’s license and an acceptable motor vehicle report under company standards are required if driving. The Fraud Claim Law Specialist designation must be obtained within the first year of hire, and attendance at the National Insurance Crime Bureau SIU Academy is required within the first two years.

Requirements

Bachelor’s degree in business, insurance, criminal justice, or a related field, or equivalent relevant experience.
Five years of claims adjusting, investigation, insurance, or related experience.
Obtain the Fraud Claim Law Specialist (FCLS) designation within the first year of hire.
Strong knowledge of investigative processes, including proper identification and collection of physical evidence.
Strong knowledge of civil and criminal investigative procedures and the legal system.
Strong knowledge of statement-taking techniques and the collection and analysis of public and private records.
Strong investigative skills and ability to make sound decisions.
Good conflict-resolution, negotiation, and facilitation abilities.
Ability to work independently and as part of a team.
Strong verbal and written communication skills, including file documentation and report writing.
Good knowledge of computers and Microsoft Office Suite.
Attend the National Insurance Crime Bureau SIU Academy within the first two years of hire.
Occasional travel.
A valid driver’s license and an acceptable motor vehicle report under company standards are required if driving.

Nice To Haves

Prior property and casualty experience.
Insurance designations such as INS or AIC.
Good knowledge of the property and casualty insurance industry and fraud awareness.

Responsibilities

Promptly investigate and evaluate moderate- to high-complexity SIU referrals, including organized ring activity.
Review claim, underwriting, and premium audit files relevant to referrals.
Contact internal departments and external parties to obtain information, including insureds, claimants, witnesses, vendors, other carriers, attorneys, and law enforcement.
Research background information, including public records, claims history, and social media.
Take statements from insureds, claimants, witnesses, and other relevant parties.
Document special investigative handling and activity.
Review investigative facts and complete field investigations.
Attend examinations under oath and depositions for assigned cases.
Secure and review bills, invoices, receipts, and other documentation for legitimacy and accuracy.
Track investigation trends and patterns related to organized ring activity.
Provide investigation status updates to branch or corporate office team members, agents, defense counsel, and law enforcement entities.
Identify, investigate, and pursue recovery or restitution opportunities.
Develop and evaluate investigative data and evidence to formulate recommendations.
Analyze investigative materials and recommend further handling, including claim payment, compromise, denial, or policy rescission.
Prepare special reports summarizing investigative data.
Communicate investigative activity and evidence to relevant branch and corporate departments and other impacted entities to support or exonerate potential fraud.
Prepare documentation in accordance with state anti-fraud reporting requirements for each investigation.
Prepare evidence packets for civil litigation or criminal prosecution for submission to defense counsel, NICB, State Fraud Bureaus, Attorney General’s offices, or other law enforcement entities.
Develop assigned internal and external anti-fraud training and market SIU services.
Provide anti-fraud training to internal and external customers through investigative discussions and educational materials.
Collaborate with team members on SIU marketing strategies and implement assigned strategies.
Participate in establishing effective policy standards, practices, techniques, and procedures for SIU referral investigation, evaluation, and disposition.
Maintain active involvement in industry professional associations.