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SIU Examiner
This a Full Remote job, the offer is available from: Louisiana (USA)
Job Summary
Responsible for identifying and handling of all aspects of claims fraud investigations. Provides expertise and claim support in reviewing SIU reported claims to include claims analysis, research, investigation, and recommendations for further handling. Coordinates SIU training with associates.
Duties and responsibilities
- Receive referrals on questionable claims or other transactions, determine if further investigation is warranted and formulate a plan of action to handle if referral accepted.
- Conduct investigation of assigned questionable claims including recorded interviews, database searches and evaluation of evidence necessary to determine the legitimacy of a claim.
- Provide reports to management and assigned examiners as to findings and possible recommendations.
- Coordinate investigations with approved SIU investigators and experts when necessary and provide guidance as needed.
- Provide coaching, direction and training to associates in the realm of SIU investigations.
- Analyze and identify trends from the claims data and provide reports when necessary.
- Provide 626 requests to other carrier’s 626 designees and respond to 626 requests from other carriers.
- Stay current on regulations and state laws. Develops fraud detection and prevention programs.
- Works with State DFS contacts and NICB.
Essential Functions
- Ability to think critically, identify, and investigate fraudulent activity and claims
- Ability to communicate verbally and in writing
- Ability to continuously research state regulations
- Ability to convey knowledge to associates
- Ability to determine appropriate course of action in fraudulent cases
Qualifications
- Louisiana Resident Adjuster License and ability to obtain and maintain reciprocal licensure for applicable states
- Associate’s Degree required; Bachelor’s Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree.
- At least 5 years of experience with a law enforcement agency or property claims handling experience.
- Demonstrated ability to research and conduct proactive investigations.
- Proficiency with Microsoft Office products required.
- Excellent communication skills, ability to interact on a professional level with internal and external personnel and partners.
- Ability to work independently in a fast-paced environment.
- Detail-oriented and exceptionally organized.
Physical requirements
While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to sit; stand; walk; use hands to grasp or feel; and reach with hands and arms, drive a vehicle
Working conditions
This position is performed remotely from a home office environment. This requires the use of standard office equipment, including computers and audio devices. Employees must maintain a reliable high-speed, password protected internet connection and a quiet, professional workspace that allows for uninterrupted work during scheduled hours. The position also requires the ability to safeguard and maintain confidentiality and security of sensitive information while working remotely.
Compensation and Benefits
We recognize that talented professionals are attracted to companies that provide a great place to work, combined with a comprehensive and competitive pay and benefits package, along with opportunities for personal growth and job advancement. For this reason we are pleased to provide:
- Market Competitive Wages commensurate with experience
- Prof. Development and Educational Assistance Programs
- Safe Harbor 401K Plan with Immediate Vesting and an Automatic Company Contribution
- Paid Time-Off (Discretionary, PTO, Parental Leave, and others)
- Company Paid Holidays
- Health Insurance
- Dental Insurance
- Vision Insurance
- Short and Long Term Disability Insurance (company paid)
- Flexible Spending Accounts with Company Contribution
- Health Savings Accounts with Company Contribution
- Employee Life and AD&D Insurance
- Dependent Life and AD&D Insurance
- Company paid AAA Membership
- Company paid Identity Theft Protection
- Other Ancillary Insurance Benefit Programs
- And more…
