Special Investigations Unit Investigator
ICW Group - San Diego, CA

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Insure Your Future Our Special Investigation Unit is expanding! We are looking for a seasoned investigator to support our efforts to combat insurance fraud.

Claim Your Role The SIU Investigator will serve primarily in a desk role to detect, prevent, and investigate suspected fraudulent claims to limit exposure and protect company assets.

Key Responsibilities
  • Maintain a systematic and effective method to detect and investigate suspected fraudulent claims and provide for their appropriate disposition.
    • Educate and train all claim handlers, underwriters and integral insurance personnel to identify possible insurance fraud.
    • Consult with appropriate personnel regarding fraud matters.
  • Provide investigative expertise to direct and conduct investigations.
    • Analyze, organize, and investigate multi-line types of fraud investigation.
    • Ensure the accuracy, quality, and timeliness of investigations.
    • Effectively apply advanced knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, and agency rules to investigations.
    • Prepare and present completed investigations to appropriate criminal justice personnel in a highly professional manner.
  • Provide superior communication, customer service and ensure relationship building with all integral personnel including Examiners, Risk Management, Auditors, Hearing Reps, Marketing, Underwriting, Claimants, Policyholders, Agents, Brokers, SIU, Legal and Medical professionals, Government/Regulatory Agencies, and Vendors.
    • Facilitate effective insurer communications with regulatory agencies.
    • Coordinate vendors to ensure appropriate outcomes and efficient pricing
Requirements Bachelor's degree (B. A. or B.S.) from four-year college or university or equivalent combination of education and experience with a minimum 2-year college degree in criminal justice or insurance claim experience. Working level knowledge of insurance and claim operations, commercial, personal, and Workers Compensation insurance products. 2-5 years SIU, legal, claims and/or law enforcement experience. Demonstrated abilities in: identifying persons or organizations involved in suspicious claims activities; working independently under minimal supervision; maintaining a strong work ethic and exercising initiative; communicating effectively both verbally and in writing. Proficient in the use of a personal computer, including MS Word, MS Excel, MS Outlook and able to learn various proprietary computer applications. Ability to travel 10% or less of time

ICW Group - 17 months ago - save job - block
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