SIU Investigator

Overview

This position, hired by a partner organization, seeks a skilled SIU Investigator located in the United States to detect and prevent insurance fraud, ensuring claims are handled fairly and accurately. You'll apply investigative expertise to analyze complex claims, collect evidence through varied methods including interviews and research, and collaborate with claims teams and external partners to uphold claim integrity.

Main Responsibilities

• Examine moderately to highly complex insurance claims flagged for potential fraud.
• Analyze claim files thoroughly and summarize findings within claim management systems.
• Conduct interviews with claimants, witnesses, and other involved parties to gather reliable information.
• Perform background checks, site inspections, surveillance, and social media assessments as necessary.
• Validate collected data and pursue additional investigative leads to confirm claim accuracy.
• Assess investigation outcomes to establish whether fraud is substantiated and if further measures are needed.
• Review results related to fraud and ensure claim decisions, including denials, are evidence-supported.
• Work closely with claims professionals, vendors, and internal teams to resolve complex investigations.
• Oversee vendor relations and evaluate external partner performance during investigative processes.
• Maintain comprehensive records, update case files systematically, and communicate results effectively.
• Pursue restitution opportunities when applicable, and return legitimate non-fraud claims for standard processing.

Candidate Requirements

• Professional experience in insurance claims, investigations, fraud detection, or a similar domain.
• Preference for candidates with automotive claims experience and full claim lifecycle knowledge.
• Strong analytical ability to interpret complex data and identify discrepancies across multiple information sources.
• Excellent critical thinking and problem-solving capabilities with sound decision-making skills.
• Experience in interviewing, evidence collection, and thorough document review.
• Effective organizational skills to manage several concurrent investigations and prioritize tasks.
• Clear and professional written and verbal communication skills suitable for documentation and team collaboration.
• Meticulous attention to detail when recording investigation information.
• Proven capacity to work autonomously while maintaining effective partnerships with internal teams and external vendors.
• Familiarity with insurance claims procedures, fraud signs, and established investigative techniques preferred.

Benefits and Work Environment

• Competitive salary range depending on level and experience: SIU Analyst III ($53,500 - $77,800), SIU Consultant I ($60,000 - $87,400), SIU Consultant II ($62,100 - $92,700), SIU Senior Consultant I ($68,500 - $104,100).
• Opportunities for additional compensation including bonuses or incentives.
• A fully remote work arrangement with provided hardware setups (laptop, monitors, headset, keyboard, mouse).
• Monthly internet connectivity reimbursement for qualifying remote employees.
• Professional development and training in investigative skills and fraud prevention.
• A collaborative and innovative environment focused on precision and customer protection.

Additional Information

This role operates via an AI-enhanced candidate matching system ensuring fair, unbiased application review. The partner company handles all subsequent hiring procedures. Data privacy is prioritized with processing under legitimate interest for recruitment, including AI-assisted resume and application analysis, while final hiring determinations are made by human decision-makers.