SIU Field Investigator

Hennessy and Roach; United States; Remote; USD 72,000 - 102,000; Full time

Job summary

A leading company is looking for a Fraud Investigator in Los Angeles to conduct complex investigations into potentially fraudulent claims. Candidates should have a strong background in investigations and preferably experience in law enforcement. The role includes conducting field investigations, using analytic tools to validate claims, and documenting findings for potential fraud cases.

Qualifications

• 2+ years of experience preferred.
• Strong background in investigations across insurance coverage.
• Preferred background in law enforcement or similar fields.

Responsibilities

• Investigate and analyze claims referred to SIU for potential fraud.
• Conduct background searches, scene investigations, and clinic inspections.
• Provide work guidance and direction to less senior employees.

Skills

Investigations

Analytical Skills

Communication

Surveillance

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 outcomes, and when no fraud or insufficient evidence is found, returns files to MCO for further handling and settlement.

Conducts thorough investigations of complex claims 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 processes.

Researches and responds to complex customer communications, concerns, conflicts, or issues.

Education: 4-year Bachelor's 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.