SIU Investigator II

EMC Insurance; United States; Remote; USD 59,000 - 82,000; Full time

Job summary

Join EMC Insurance as a Special Investigations Unit investigator. You will conduct investigations into claims of moderate complexity, assess evidence, and ensure compliance with anti-fraud regulations. This remote role provides an opportunity to contribute meaningfully to the insurance field while working independently and collaboratively.

Qualifications

• 3 years of claims adjusting, investigation, or insurance-related experience required.
• Fraud Claim Law Specialist designation within the first year of hire.
• Insurance designations such as INS, AIC, and FCLS preferred.

Responsibilities

• Investigate and evaluate claims of moderate complexity.
• Communicate with various parties to obtain information.
• Prepare special reports and documents per investigations.

Skills

Investigative skills

Conflict resolution

Communication skills

Education

Bachelor’s degree in business, insurance, or criminal justice

Tools

Microsoft Office Suite

Job description

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.

**This position is eligible to work from home anywhere in the United States**

Essential Functions:

• Promptly investigates and evaluates SIU referrals of moderate complexity, including organized ring activity:
• Reviews claim, underwriting and premium audit files pertinent to the referral
• Initiates contact with other departments, insureds, claimants, witnesses, vendors, other carriers, attorneys, law enforcement or any others to obtain information
• Researches background information, including public records, claims history and social media sites
• Takes statements from insureds, claimants, witnesses and other pertinent parties.
• Documents all special investigative handling and activity
• Reviews the facts of an investigation and completes field investigations
• Attends examinations under oath (EUOs) and depositions for assigned cases
• Secures and reviews bills, invoices, receipts and other documentation for legitimacy and accuracy
• Provides status updates on special investigations to branch or corporate office team members, agents, defense counsel and law enforcement entities
• Identifies, investigates and pursues opportunities for recovery or restitution
• Develops and evaluates investigative data and evidence to formulate recommendations:
• Conducts analysis of all investigative materials to formulate a recommendation for further handling, including payment, compromise or denial of a claim or rescission of a policy
• Prepares a special report with written summaries of all investigative data
• Communicates with branch and corporate office departments, as well as other impacted entities, regarding investigative activities and evidence to support or exonerate potential fraud
• Prepares documentation in compliance with a state’s anti-fraud reporting requirements on each investigation
• Prepares evidence packets related to civil litigation or criminal prosecution for submission to defense counsel, National Insurance Crime Bureau (NICB), State Fraud Bureaus and/or Attorney General’s offices or other law enforcement entities
• Participates in internal anti-fraud training and marketing of SIU services:
• Participates in the development of anti-fraud training
• Provides anti-fraud training to internal customers through investigative discussions and dissemination of educational materials
• Collaborates with team members in developing marketing strategies for the SIU department and its services
• Participates in the establishment of effective policy standards, practices, techniques and procedures for the investigation, evaluation and disposition of the SIU referral. Maintains active involvement in professional associations within the industry.

Education & Experience:

• Bachelor’s degree in business, insurance, criminal justice or related field or equivalent relevant experience
• Three years of claims adjusting, investigation or insurance-related experience or related experience
• Prior property and casualty experience preferred
• Fraud Claim Law Specialist designation within the first year of hire
• Insurance designations, such as INS, AIC, and FCLS preferred

Knowledge, Skills & Abilities:

• Good knowledge of the investigative process, including proper identification and collection of physical evidence
• Good knowledge of civil and criminal investigative procedures and the legal system
• Good knowledge of various statement taking techniques, collection and analysis of public and private records
• Knowledge of property and casualty insurance industry and fraud awareness preferred
• Good investigative skills and the ability to make sound decisions
• Good conflict resolution, negotiation and facilitation abilities
• Ability to work independently and as part of a team
• Strong verbal and written communication skills, including file documentation and report writing
• Good knowledge of computers and Microsoft Office Suite
• Attendance of the National Insurance Crime Bureau SIU Academy within the first two years of hire
• Occasional travel; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving

The hiring salary range for this position will vary based on geographic location, falling within either the $59,463-$81,943 range or the $65,568-$90,343 range. A hiring range represents a subset of the full salary range. The actual salary will depend on several factors, includingrelevant education, skills, and experience of an applicant, geographic location, and business needs.

Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.

All of our locations are tobacco free including in company vehicles.