Claims - SIU Research Investigator

PURPOSE OF THE POSITION

The SIU Research Investigator is responsible for supporting fraud detection and claims investigations through comprehensive research and analysis utilizing public records, subscription databases, and specialized investigative tools. This role conducts detailed research investigations to identify potential fraud indicators, gather relevant evidence, and support Special Investigations Unit (SIU) activities.

The SIU Research Investigator performs background investigations, social media analysis, database research, and other investigative activities to assist claims professionals and legal partners in identifying suspicious claims activity. This role compiles investigative findings into clear, detailed reports and communicates potential red flag indicators and recommendations for further investigation.

The SIU Research Investigator maintains a solid understanding of the company mission, vision, and values, and upholds the standards of the Company while ensuring all investigative activities are conducted ethically and in compliance with applicable laws and regulations.

RESPONSIBILITIES

• Performs research investigations in support of claims examiners, clients, and legal counsel related to potential fraudulent claims activity.
• Conducts thorough searches of public records and subscription databases to identify relevant information related to claimants, insureds, witnesses, and other involved parties.
• Performs comprehensive background investigations, including review of public records, employment history, medical providers, and other relevant sources.
• Conducts social media searches, social media monitoring, and other specialized investigative activities.
• Identifies, analyzes, and documents potential fraud indicators or other red flags discovered during the investigative process.
• Compiles research findings and prepares clear, professional investigative reports documenting all relevant facts and evidence.
• Communicates investigative findings and recommendations to leadership, claims examiners, and other internal stakeholders as appropriate.
• Maintains accurate and timely documentation of all investigative activity within the appropriate claim handling systems and internal databases.
• Ensures investigations are completed in accordance with established service expectations, regulatory requirements, and SIU best practices.
• Maintains knowledge of applicable legal requirements, investigative procedures, and ethical standards related to insurance fraud investigations.
• May participate in depositions or courtroom testimony as requested related to investigative findings.
• Assists in training or mentoring new team members on investigative processes, tools, and best practices when requested.
• Performs other functional duties as required.

KNOWLEDGE, SKILLS AND ABILITIES

Candidates Must Have:

• Strong analytical and problem-solving skills with the ability to interpret information, evaluate facts, and apply critical thinking throughout the investigative process.
• Demonstrated case management skills with the ability to organize, prioritize, and manage assignments independently.
• Ability to perform effectively in a high-volume, fast-paced environment while managing multiple competing priorities.
• Working knowledge of insurance and claims operations, including Commercial Lines, Personal Lines, and other insurance products.

Education / Licensing / Experience:

• Bachelor's degree/or equivalent work experience (with high school diploma).
• Five (5) years of insurance industry experience, investigative experience, or a related field, or equivalent combination of education and experience.
• Experience supporting insurance fraud investigations or SIU functions preferred.

Technical Skills:

• Experience conducting research using public records and subscription investigative databases.
• Ability to prepare professional investigative documentation and reports.
• Ability to manage case documentation and investigative materials within claim management systems.
• Strong organizational skills with ability to manage investigative documentation and evidence effectively.
• Ability to maintain confidentiality of sensitive information.
• Highly organized and excellent time management skills required.
• Excellent oral, written and interpersonal communication skills.
• Effective and efficient use of computer applications including MS Office products.

The above statements are intended to describe the general nature and level of work being performed by the incumbents of this job. They are not intended to be an exhaustive list of all responsibilities and activities required of this position.

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person