Job Description

We are currently recruiting for a SIU Claims Investigator in Hartford, CT. This is a hybrid role (2 days in-office, 3 days remote). The Claims SIU Investigator will identify and mitigate risks associated with fraudulent claims. This individual will analyze and investigate claims referred to the Claims Special Investigation Unit (Claims SIU) for potential fraud. 100K - 125K Base + Bonus + Benefits package

Responsibilities:

• Collaborate with the Claims SIU Manager, external SIU vendors, and business partners regarding investigative assignments
• Validate the facts of loss and coordinate the investigation of Claims
• Conduct background searches, coordinate scene investigations, take statements, review and analyze claim documentation, coordinate/conduct witness interviews, complete social media searches, and coordinate surveillance
• Enter SIU data and claim into business systems, validate fraud outcomes based on investigations, prepare detailed verbal and written investigative reports summarizing results and recommended actions
• Utilize analytical tools and data to identify claims for investigation or for supporting evidence of fraud and damages
• Build and maintain relationships with internal and external stakeholders (NICB, DOI, SIU, and Law Enforcement)
• Obtain and summarize claim files acquired from other insurers in support of open SI investigations
• Assist the Claims SIU Manager with providing stakeholder training, along with promoting Fraud Awareness to the Claims Department and Business Partners
• Ensure compliance with state fraud-related laws and regulations

Requirements:

• 5 years of analytical/investigative experience in insurance
• Extensive knowledge and experience in all levels of claims investigation, fraud investigation, and regulatory reporting requirements
• Bachelor’s degree or equivalent work experience
• Fraud Claims Law Specialist (FCLS), Fraud Claims Law Associate (FCLA), Certified Fraud Examiner (CFE), and/or IASI Certified Insurance Fraud Analyst (CIFA) designation preferred
• Proficiency with external database tools such as ISO, social networking platforms, and internet searching
• The ability to identify and recognize red flags in data

Local candidates only. Must be in the Hartford, CT area. Hybrid in-office 2 days. 100K-125K + bonus + benefits package.

Job Tags

Similar Jobs