SIU Field Investigator

Agnello & Rogers; United States; Remote; USD 72,000 - 102,000; Full time

Job summary

A leading company is looking for a Fraud Investigator to join their Special Investigations Unit (SIU) in Los Angeles, CA. This field-based position involves conducting complex investigations into potentially fraudulent claims across various insurance lines. Candidates should have a strong investigative background, preferably in law enforcement, and be adept at analyzing various forms of evidence to determine the validity of claims. The role includes mentoring juniors and utilizing analytic tools to support the investigation process.

Qualifications

• 2 or more years of experience preferred.
• Background in law enforcement or a similar field is highly preferred.
• Strong background in investigations across multiple lines of insurance coverage.

Responsibilities

• Conduct thorough investigations involving background searches and scene inspections.
• Analyze claims for potential fraud and validate investigation outcomes.
• Conduct online searches and evaluate complex customer communications.

Skills

Investigative skills

Analytical skills

Communication

Education

4 year Bachelor's Degree

Job description

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 position within our Special Investigations Unit (SIU) Fraud Investigation Department, responsible for conducting complex field fraud investigations. The ideal candidate must reside in or around Los Angeles, California. We are seeking candidates with a strong background in investigations, ideally with experience across multiple lines of insurance coverage. A background in law enforcement or a similar investigative field is highly preferred.**

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

Education
4 year Bachelors Degree (Preferred)

Experience
2 or more years of experience (Preferred)

Supervisory Responsibilities
This job does not have supervisory duties.

Compensation

Base compensation offered for this role is $72,890 – $101,365 annually and is based on experience and qualifications.