Auto Insurance Fraud Investigator SIU - Houston, Texas

United Auto Insurance; Houston (TX); Remote; USD 65,000 - 95,000; Full time

Benefits offered by this job

401(k) match

Medical, vision, dental insurance

Paid time off

Flexible spending accounts

Life insurance and disability

Job summary

United Automobile Insurance Company is seeking an Insurance Fraud Investigator (SIU) in Houston, TX. The role involves conducting field and desk investigations to detect fraud in high complexity auto claims, coordinating with NICB and law enforcement, and preparing detailed reports.

The ideal candidate has bilingual English/Spanish capabilities, strong analytical and interviewing skills, and an Associate or Bachelor's degree with 5 years of related experience.

Qualifications

• Associate or bachelor's degree in a related field preferred and/or 5 years of related work experience.
• Bilingual English and Spanish proficiency is required.
• Strong analytical and investigative interviewing abilities.

Responsibilities

• Conduct field and desk investigations into high complexity auto fraud claims.
• Collect and analyze data from reports to identify patterns of fraud.
• Prepare comprehensive investigation reports for approval.
• Maintain liaison with NICB, law enforcement, and external partners.
• Mentor junior investigators and share best practices.

Skills

Bilingual English Spanish

Analytical skills

Interviewing

Organizational skills

Team collaboration

Education

Associate or Bachelor's degree in related field

5 years related work experience

Tools

CPT codes

Medical terminology

Job description

COMPANY OVERVIEW

Founded in 1989, United Automobile Insurance Company is an innovative and established organization looking for Insurance Fraud Investigator (SIU) to join our team. Family-owned, UAIC, is one of the largest privately held property and casualty insurance companies in the United States. The key to our growth and success is a commitment to providing quality service to our agents and customers, by providing disciplined underwriting, and strategic claims handling. Our ongoing efforts to invest substantial resources in personnel and technology are the foundation of our promise of assuring maximum efficiency and specialized operations in the industry. We are proud that our independent agents and customers have recognized our dedication by making UAIC the market leader in every state where we conduct business.

Remote position, and must be located in the Houston, Texas

SCOPE

As a Insurance Fraud Investigator I(SIU) for UAIC, you will be responsible for conducting field as well as desk investigations to detect fraud on high complexity claims involving staged auto accidents, fraud rings, and questionable medical treatment. You will provide investigative expertise to limit exposure and protect company assets. These investigations involve auto liability private passenger and commercial auto lines for non-standard policies. Investigations may include database searches, Examinations Under Oath, and scene canvasses. Focusing on thoroughness, quality, timeliness, and cost control. Our special investigator II will prepare and submit SIU investigative reports covering all phases of the investigation in each case for approval. You will maintain continued contact during investigations with supervision, internal legal professionals, external medical professionals, government/regulatory agencies, NICB, Law Enforcement, and outsourced vendors. The Investigator will also be responsible for effectively carrying out investigations of alleged Fraud, Waste, and Abuse by medical providers, body shops, and others.

DUTIES

• Conduct clinic inspections and examinations under oath.
• Conduct in-depth research and review of suspected fraudulent or abusive patterns to develop sufficient evidence to conclusively establish facts involving insureds, claimants, medical and auto body shop providers, or other entities.
• Collect, utilize, and interpret data from a variety of computer-generated reports and other sources; thereby identifying and documenting questionable patterns related to medical modalities, procedures, and other practices which merit further investigation.
• Maintains assigned investigation files, documents evidence, and prepares comprehensive investigation reports at the completion of each investigation.
• Assist in conducting comprehensive interviews: medical and other providers aforementioned, insureds/claimants in the presence of their attorneys where applicable, and witnesses to obtain statements and information admissible under accepted rules of evidence in civil and criminal court proceedings.
• Conducts special projects initiatives/investigations referred by the House Counsel.
• Establishes and maintains liaison with NICB, Law Enforcement officers, and others to obtain assistance in conducting, facilitating, and enhancing investigations.
• Knowledgeable about all applicable insurance regulations, especially PIP regulations to ensure duties and assignments are carried out within the requirements of applicable law and office expectations.
• Mentor and teach less experienced investigators, promoting teamwork and collaboration among the department. Encourage sharing of insights, experiences, and best practices within the SIU team.

EDUCATION

• Associate or bachelor's degree in a related field preferred and/or 5 years of related work experience.

SKILLS & EXPERIENCE

• Bilingual (English & Spanish)
• Knowledge of current procedural terminology.
• Strong critical thinking and analytical skills with the ability to interpret data and trends.
• In-depth knowledge of applicable fraud statutes, regulations, and industry best practices.
• High degree of integrity as demonstrated by appropriate treatment of confidential information, and adherence to policies, rules, and regulations.
• Effective communication and interpersonal skills, with the ability to build and maintain relationships with internal and external stakeholders.
• Excellent organizational and project management abilities, with a keen eye for detail.
• Expert knowledge of medical claims processing and investigations, a strong plus.
• Experience in CPT codes and medical terminology is highly preferred.
• Detail-oriented investigator with strong organizational and time management abilities
• Analytical and interview skills: ability to make deductions; logical and sequential thinker.
• Computer literate; database and Internet proficient. Has knowledge of available resources (internal and external) to assist in investigations.
• Ability to work with others in a team environment.

BENEFITS

• 401(k) Retirement Savings Plan with employer match.
• Comprehensive Medical, Prescription Drug, Vision, and Dental Insurance
• Paid Time Off, Holidays, and Leave programs.
• Flexible spending accounts
• Basic Life Insurance and Voluntary Life/ADD
• Short Term and Long-Term Disability

UAIC participates in the E-Verify program to confirm the employment eligibility of all newly hired employees. For more information about E-Verify, please visit https://www.e-verify.gov/.

UAIC is an Equal Opportunity Employer and is committed to the principle of equal employment opportunity for all employees. All employment decisions at UAIC are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, or belief, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.

Compensation Notice: Compensation ranges and estimates displayed by third-party job platforms may be automatically generated and may not reflect United Auto Insurance's established compensation range for this position. Where required by applicable law, United Auto Insurance will provide the applicable pay range and other required compensation information. For questions regarding compensation for this position, please contact our Recruiting Team.