SIU Triage Analyst

Core Specialty Insurance Holdings, Inc.•Dallas, TX

1d•Hybrid

About The Position

A multi-state commercial insurance carrier is seeking a Special Investigations Unit (SIU) Triage Analyst. This role involves identifying, assessing, and prioritizing suspicious insurance claims or financial transactions to detect fraud, waste, and abuse. The analyst will review referrals from claims staff, analyze initial loss reports for red flags, assign cases to investigators, and ensure regulatory compliance. Candidates who can work on a hybrid basis out of Dallas, TX are preferred. Core Specialty offers a diversified range of property and casualty insurance products for small to mid-sized businesses, focusing on niche markets, local distribution, and superior underwriting knowledge across the U.S.

Requirements

Basic proficiency in Microsoft Office including Word, Excel, Outlook.
Understanding various lines of insurance, state insurance regulations, legal concepts and medical terminology.
Detailed oriented with the ability to work in a team environment and be flexible to daily changing needs and job duties.
Ability to analyze and solve problems, working closely with others to coordinate and complete projects.
Excellent oral, written, and interpersonal communication skills.
Must be customer service oriented, highly organized, and efficient.
Proficiency with MS Office (Excel).
Experience using multiple investigative databases to include but not limited to: TLO, ISO, Accurint, etc.
2–4+ years of claims/investigative experience with an ability to recognize red flags and fraud indicators across multiple lines of insurance.
Applicants must be authorized to work for any employer in the U.S.

Nice To Haves

A bachelor’s degree in criminal justice, Finance, or a related field.
Industry related professional designations such as FCLS, FCLA, and/or CIFI.

Responsibilities

Review and analyze incoming referrals to determine if they meet criteria for further investigation, accepting or rejecting them within strict timelines.
Set up new cases in the SIU case management system and assign cases that meet the threshold to investigators while providing necessary background documentation.
Analyze claim data and utilize database tools to identify fraud indicators and suspicious patterns.
Conduct data analysis and utilize analytical tools to identify suspicious claims.
Submit investigative assignments to vendors to include surveillance and manage those assignments accordingly.
Review vendor reports to identify red flags and/or fraud indicators that might warrant further investigation by the SIU.