Senior SIU Investigator

Senior SIU Investigator

Encova Insurance is seeking a Senior SIU Investigator. This role will be home-based but you must reside in Pennsylvania. This role will report to the Manager, Special Investigations.

The SIU investigator is responsible for the review, acceptance, action planning, investigation and documentation of suspect claims. The SIU investigator is the subject matter expert on insurance fraud and communicates directly with all levels of claims personnel with regard to investigative strategies and conclusions. The SIU investigator is responsible for fraud recognition training for claims personnel and agents and provides administrative record keeping on suspicious claim fraud for management, law enforcement, and resolution specialists.

Essential functions include reviewing referred suspicious claims and identifying the scope of investigation needed, investigating assigned suspicious claims, determining and interviewing all parties who are material to the investigation, performing investigative fieldwork to verify information and / or investigative leads, utilizing appropriate databases, informational resources and public records to verify information and / or investigative leads, assigning and overseeing investigative vendors, identifying and communicating relevant coverage issues during the course of the investigation, independently analyzing data and facts to develop action plans and provide investigative conclusions, preparing complete, detailed, and accurate narrative investigation reports, and assisting in the mentoring, development and providing of technical direction to other SIU investigators.

Other functions include developing and mentoring claims personnel regarding insurance fraud issues, developing and coordinating training for SIU investigators in all phases of the investigation process, working closely and communicating effectively with resolution specialists and claims leadership, assisting with fraud recognition training for resolution specialists and agents, keeping statistical data for transfer into SIU database and assisting in developing data collection methods, assisting with and participating in examinations under oath, reviewing investigative results with resolution specialists and leadership before the claim is resolved, appearing in court as a company representative when needed, representing SIU during claim reviews when needed, assisting in development of SIU field investigation standards and procedures, generating and submitting fraud reports to insurance departments, and performing other duties as assigned.

Knowledge, skills and experience required include at least three years' experience in law enforcement, SIU investigation, or claims supervision; or at least four years as a resolution specialist, multi-line insurance background, strong interviewing and investigative proficiency, strong interpersonal skills and organizational and analytical skills, strong case management, communication and presentation skills, a thorough understanding of claims processes and procedures, a college degree or equivalent experience in insurance, and the professional designation of CIFI (IASIU's Certified Insurance Fraud Investigator) or attainment within 1 year of becoming and SIU Senior Investigator, and the professional designation of FCLA (American Education Institute Fraud Claims Law Associate) within 2 years of becoming an SIU Senior Investigator.