The Special Investigation Unit of Delta Group investigates and identifies questionable and suspicious claims for our partners, communicating with claims personnel, insurance carrier SIU staff, law enforcement, and government regulatory agencies to identify, prevent and deter fraud. The candidate should have extensive experience with claims for all lines of insurance, with a heavy emphasis on Workers' Compensation claims.
JOB DUTIES:
- Conduct timely investigations including recorded statements and interviews of claimants, witnesses, and employers.
- Provide timely status updates to case manager and client.
- Timely and clear documentation of the claim files.
- Maintain highest level of confidentiality and professionalism.
- Develop appropriate investigative action plan.
- Ensure accuracy, quality and timeliness of the evidence gathered during an investigation as well as compliance with all applicable laws, legal codes, and governing agencies.
- Provide Claim Adjuster with timely investigation results and document investigative findings.
- Determine whether additional evidence is required including but not limited to accident reports, accident scene reconstructions, witness statements, police reports, expert opinion, etc.
- Provide recommendations and decisions surrounding investigative efforts.
- Perform detailed database queries on SIU investigations to include analysis and organization of critical data to assist during the assigned investigation.
- Be able to evaluate State compliance referrals, as applicable, when questionable or suspicious activity is identified.
- Maintain active membership in professional organizations that provide SIU assistance and resources..
- Establish and maintain relationships with law enforcement, government regulatory agencies and insurance industry personnel assisting when needed or required.
JOB REQUIREMENTS:
- Strong investigative skills necessary
- Must be detail oriented
- Ability to recognize patterns of inconsistencies that may be linked to fraudulent activity
- Must have ability to interact with clients, repair shops and appraisers, and employers.
- Ability to work independently
- Excellent verbal and written communication skills
- Good organization and time management skills
- Demonstrate knowledge of tools and techniques needed for conducting insurance claims investigations
- Demonstrate proficiencies with computer software, Word, Excel, Outlook and Teams
EQUIPMENT NEEDED:
- Laptop Computer
- Cell Phone
- Audio Recording device with download capability
- Digital Camera
- Tape measure
EDUCATIONAL REQUIREMENTS:
- CFE or FCLS designations preferred
- 5-10 years' experience in claims and SIU investigations preferred
The final job level and annual salary will be determined based on the education, qualification, knowledge, skills, ability, and experience of the final candidate(s), and calibrated against relevant market data and internal team equity.
