Sr Claim Triage Specialist- SIU (Hybrid)

MAPFRE•Webster, MA

1d•$67,600 - $87,000•Hybrid

About The Position

This role is responsible for front-end claim triage and preliminary investigation across multiple Lines of Business and jurisdictions. You will play a critical role in identifying potential fraud indicators, coverage anomalies, and risk exposure at the earliest stages of a claim. Rather than owning claims end-to-end, you will serve as a key decision point in the process—reviewing referrals, conducting targeted investigative activity, analyzing claim data, and determining the appropriate next steps. This may include escalation to SIU field investigations, specialized claim units, legal partners, or external resources. Your contributions will directly support stronger claim outcomes through early detection, thorough documentation, intelligence development, and timely escalation.

Requirements

Bachelor’s degree or equivalent specialized experience
4–6 years of experience or Associate’s degree with 6–8 years of experience
Minimum 4 years of claims and/or SIU adjusting experience required

Nice To Haves

Insurance coursework strongly preferred
Bilingual skills are a plus

Responsibilities

Deliver Exceptional Customer Service: Demonstrate and uphold all customer service standards, including adherence to mandated deadlines. Interact with insureds, claimants, internal partners, and external entities with empathy, professionalism, and respect. Ensure all communication (written, verbal, and voicemail) is timely, clear, accurate, and professional. Collaborate effectively with team members and proactively support department and organizational goals. Maintain proficiency in Claims Operational Systems to support efficient claim handling.
Apply Technical Expertise: Use strong business judgment to interpret policies, coverage, endorsements, and claim details. Identify fraud indicators, inconsistencies, documentation gaps, and potential risk exposure. Conduct limited investigative activities, including interviews, fact gathering, database searches, and public record research. Manage multiple priorities in a fast-paced environment while maintaining confidentiality and regulatory compliance. Communicate effectively with all stakeholders while exercising sound judgment and discretion.
Drive Quality & Productivity: Review new loss notices, referrals, and escalations using established triage criteria and red-flag indicators. Determine appropriate claim routing and prepare thorough, accurate referral documentation. Maintain high-quality documentation that supports audit readiness and regulatory requirements. Track referral outcomes and manage investigative and legal expenses within guidelines. Meet or exceed performance expectations across productivity, service, and quality metrics.
Lead Through Influence: Serve as a subject matter resource for fraud indicators and claim triage best practices. Mentor and support the development of less experienced adjusters and colleagues. Participate in training programs, committees, and process improvement initiatives. Represent the organization in industry forums and professional settings as appropriate. Demonstrate accountability, professionalism, and commitment to continuous development.