SIU Field Investigator

Rhode Island Bar Assn.; United States; Remote; USD 60,000 - 85,000; Full time

Job summary

A leading association seeks a skilled Fraud Investigator for their Special Investigations Unit. The role involves conducting in-depth field investigations and analyzing complex claims for potential fraud, requiring strong analytical abilities and a background in investigations, especially in insurance. Candidates located near Northern New Jersey are preferred, as the position involves significant local travel.

Qualifications

• 5+ years of experience in fraud investigation or similar field preferred.
• Background in law enforcement is a plus.
• Experience in handling complex claims in insurance is essential.

Responsibilities

• Conducts complex fraud investigations including field inspections and surveillance.
• Analyzes claims and validates information related to potential fraud.
• Mentors junior team members and provides guidance.

Skills

Investigations

Analytical Skills

Attention to Detail

Customer Communication

Education

4 year Bachelors 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 near Northern New Jersey, specifically in the Passaic, Bergen, or Hudson County areas. We are seeking candidates with a strong background in investigations, ideally with experience across multiple lines of insurance coverage, including homeowners insurance. A background in law enforcement or a similar investigative field is preferred. Prior SIU field experience 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
5 or more years of experience (Preferred)

Supervisory Responsibilities
This job does not have supervisory duties.