SIU Field Investigator

Overview

This job is responsible for investigating and analyzing complex, multi-discipline coverage and claims that have been referred to the special investigation unit (SIU) for potential fraud. This role typically handles a combination of complex attorney represented and unrepresented claims and moderate to complex losses, in which suspicious activity has been identified. The individual performs a thorough investigation including; (1) conducting background searches, scene investigations, and clinic inspections; (2) taking recorded statements; (3) reviewing and analyzing medical notes, bills, and property damage; and (4) conducting witness interviews and social media searches. The individual conducts surveillance on property and / or creates scene reconstructions on some investigations and reviews whether fraud can be substantiated and supports a lawsuit. The individual provides work guidance and direction to less senior employees and provides mentoring and coaching to the team.

This is a field-based, location-specific role based in the Central to Southern Louisiana area. The ideal candidate will reside in or near one of the following cities : Opelousas, Alexandria, Baton Rouge, Lafayette, or the surrounding areas.

Key Responsibilities

• Reviews investigations with fraud outcomes to validate whether denial is appropriate
• Conducts complex site inspections, including body shops, medical clinics, loss locations etc.
• Conducts complex online data application searches, research, and evaluation
• Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads
• Enters SIU claim data information into multiple SIU systems
• Updates files with investigation outcome, and when no fraud or insufficient evidence is found, returns file to MCO for further handling and settlement
• Conducts thorough investigations of complex that are potentially fraudulent to determine if payment is warranted, including scene investigations and surveillance as needed
• Utilizes analytic tools or SIU field intelligence to identify complex claims for investigation and / or for support in the evidence of the fraud and damages
• Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision-making process
• Researches and responds to complex customer communications, concerns, conflicts or issues

Supervisory Responsibilities

This job does not have supervisory duties.

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