The SIU Manager is responsible for assisting with leading our anti-fraud efforts to include both commercial and personal lines of business. This role is critical in safeguarding the integrity of our claims process, mitigating financial losses, and ensuring compliance with regulatory mandates.

The SIU Manager will be responsible for overseeing a team of investigators and support specialists, managing complex and high-exposure investigations, and assisting with investigative tools to support the enterprise anti-fraud efforts. This position requires a deep understanding of commercial and personal insurance operations, investigative techniques, and regulatory frameworks.

Key Functions/Duties of Position:

Leadership & Strategy

• Lead, mentor, and manage a team of SIU investigators and support specialists, ensuring high performance, professional development, and adherence to best practices.
• Execute a strategic vision for fraud detection and prevention across all lines of business.
• Establish and monitor key performance indicators (KPIs) to measure the effectiveness of the SIU program.
• Collaborate with senior leadership to align SIU goals with broader organizational objectives.

Investigative Oversight

• Oversee the intake, triage, and assignment of suspected fraudulent claims, ensuring timely and thorough investigations.
• Direct the investigation of complex, high-value, or sensitive cases involving potential fraud, collusion, staged losses, or organized crime.
• Ensure investigative activities are conducted in accordance with legal standards, company policies, and industry best practices.
• Review and approve investigative reports, summaries, and referrals to law enforcement or regulatory bodies.

Quality Assurance & Compliance

• Manage and implement a comprehensive quality assurance program to evaluate the accuracy, completeness, and compliance of SIU investigations.
• Conduct regular audits of investigative files to ensure adherence to internal protocols, regulatory requirements, and industry standards.
• Provide feedback and coaching to investigators based on audit findings to drive continuous improvement.
• Monitor trends in investigative performance and develop targeted training or process enhancements as needed.
• Ensure timely and accurate reporting to state fraud bureaus, the NICB, and other regulatory entities.

Compliance & Reporting

• Ensure compliance with all applicable state and federal regulations, including mandatory fraud reporting requirements.
• Maintain accurate and timely documentation of all investigative activities in the case management system.
• Prepare and submit regulatory reports, internal dashboards, and executive summaries as required to SIU Leadership.
• Serve as a primary liaison with state fraud bureaus, the National Insurance Crime Bureau (NICB), and other external agencies.

Collaboration & Training

• Partner with claims, underwriting, legal, and risk management teams to identify fraud trends and vulnerabilities.
• Provide training and guidance to claims staff on fraud indicators, red flags, and referral procedures.
• Represent the company at industry conferences, fraud task forces, and professional associations.

Technology & Innovation

• Leverage data analytics, predictive modeling, and fraud detection software to enhance investigative capabilities.
• Evaluate and implement new tools and technologies to improve SIU efficiency and effectiveness.

Education Requirement:

Bachelor’s degree in Criminal Justice, Insurance, Business Administration, or a related field

Minimum of 7–10 years of experience in insurance fraud investigations, with minimum of 3 years in a supervisory or managerial role.

Extensive knowledge of commercial and personal insurance products and claims processes.

Completion of one or more of the following designations:  Fraud Claims Law Specialist (FCLS), Certified Insurance Fraud Investigator (CIFI), Certified Fraud Examiner (CFE), Chartered Property Casualty Underwriter (CPCU), Associate in Claims (AIC)

Qualifications: 

Leadership & Management

• Team Leadership: Proven ability to lead, mentor, and develop high-performing investigative teams, fostering a culture of accountability, integrity, and continuous improvement.
• Strategic Thinking: Strong capability to align investigative operations with organizational goals, anticipate fraud trends, and proactively adapt strategies.
• Decision-Making: Skilled in making sound, data-driven decisions under pressure, especially in high-stakes or time-sensitive investigations.

Investigative Expertise

• Analytical Thinking: Advanced analytical skills to identify patterns, anomalies, and red flags in complex commercial claims data.
• Interview & Surveillance: Proficiency in investigative techniques including interviewing witnesses, claimants, and suspects, as well as coordinating surveillance and field investigations.
• Evidence Evaluation: Ability to assess the credibility, relevance, and admissibility of evidence in support of fraud determinations or legal proceedings.

Regulatory & Legal Knowledge

• Compliance Awareness: Deep understanding of state and federal fraud reporting requirements, insurance regulations, and industry standards (e.g., NAIC Model Fraud Plan).
• Legal Collaboration: Experience working with legal counsel on case development, litigation support, and regulatory inquiries.
• Documentation & Reporting: Skilled in preparing detailed, accurate, and legally sound investigative reports and summaries.

Quality Assurance & Process Improvement

• Audit & Review: Experience designing and executing quality assurance programs to evaluate investigative performance, compliance, and outcomes.
• Process Optimization: Ability to identify inefficiencies in investigative workflows and implement process improvements to enhance productivity and consistency.
• Training & Development: Strong capability to develop and deliver training programs that elevate fraud awareness and investigative acumen across the organization.

Technology & Tools

• Case Management Systems: Proficiency in using SIU case management platform
• Data Analytics: Familiarity with fraud analytics tools, predictive modeling, and data visualization platforms

Communication & Interpersonal Skills

• Written Communication: Exceptional writing skills for composing clear, concise, and persuasive investigative reports, executive summaries, and regulatory filings.
• Verbal Communication: Strong presentation and interpersonal skills for communicating findings to internal stakeholders, law enforcement, and regulatory bodies.
• Collaboration: Ability to build cross-functional relationships with claims, underwriting, legal, compliance, and external partners.

Ethical Judgment & Integrity

• Confidentiality: Demonstrated commitment to maintaining the confidentiality and integrity of sensitive information.
• Ethical Standards: High ethical standards and a strong sense of professional responsibility in handling investigations and decision-making.