Plan, organize, and conduct investigations of suspicious claims/matters while maintaining proper reserves. Recommend disposition of suspicious claims/matters in a prompt and expeditious manner. This can include the evaluation, adjustment, and negotiation of claim/lawsuit files.
Testify in civil and criminal matters, attend mediations, depositions, settlement conferences, and trials.
Maintain and pursue technical competency by attending insurance fraud training schools, seminars and company sponsored courses.
Develop and maintain liaisons with NICB, State Fraud Bureaus, company personnel, and the industry.
Organize and participate in fraud awareness training as required.
Utilize computer generated reports and work with company personnel to assist in the detection of suspicious claims.
Assist in the selection of approved attorneys and independent investigators.
Work within the various state laws, regulations and fair claims practice acts.
Work toward improving workflow or establishing a more efficient method to investigate claims.
Assist the SIU Manager and SIU Director on an as needed basis.
Exercise a high degree of discretion and confidentiality at all times.
*PLEASE NOTE: Depending upon the qualifications of applicants, another level may be substituted for this position.
Educational Equivalent – College degree preferred with emphasis in
criminal justice. IIA, FCLA or FCLS designation desired.
Specialized Training – Prior experience handling suspicious insurance claims is preferred, including previous training or experience in determining liability, negotiating settlements, reviewing estimates and understanding medical terminology. Property Claims experience preferred.
Specific Abilities – Availability to travel, sometimes on short notice, to attend mediations, depositions, trials, examinations under oath and testify at civil and criminal proceedings. Organize and participate in fraud awareness training as required. Good claims investigative skills. Capacity to obtain and maintain licenses in all states in which we do business. Ability to handle auto and homeowner first and third party claims to conclusion including litigation. Ability to negotiate claim settlements effectively with attorneys. Must be able to work with defense attorneys, the public and company personnel cordially and respectfully. Must have high level of organizational and task-management skills with attention to detail. Ability to analyze, interpret, and evaluate information from various sources. Must have excellent communication skills, both written and oral. Ability to work independently and in a team environment under tight deadlines. Must be able to use a PC effectively including Word, Excel and Outlook. Ability to type 40 wpm.
Specific Knowledge - Experience or training in fraud prevention,
detection, and investigative techniques preferred. Knowledge of policy
and coverages wtih background in mulit-line claims handling preferred.
Medical terminology is helpful.