Claims SIU Specialist

Summary:
This role is primarily responsible for identifying, investigating, and adjudicating suspicious and fraudulent insurance claims. This position will work to prevent fraud, protect company assets and ensure that legitimate claims are processed fairly. The role involves analyzing claims, conducting interviews, gathering evidence, and collaboration with other departments and law enforcement when necessary. This role will include management of SIU vendors, evaluation of field investigators, liaison with Jewelers Security Alliance, and facilitation of annual SIU training and certification.

This role includes significant engagement with Claim Examiners, SIU vendors, adjusters, attorneys, Personal Lines Underwriting, Commercial Lines Underwriting, Asset protection, and JSA (Jewelers Security Alliance). The ideal candidate will be able to work on site at our home office location.

Why Jewelers Mutual:
Since 1913 we’ve been committed to supporting the Jewelry industry and putting customers at the center of everything we do. With over a century of trusted expertise, we’re financially strong, forward-thinking, and driven by curiosity. Guided by our core values of Agility, Accountability, and Relevancy, we lead through innovation.

As a technology focused organization, we embrace cutting-edge tools and data-driven insights to continuously improve our products, services, and customer experience. Our mission is to be the industry’s most trusted advisor by investing in our people, adopting new technologies, and striving for excellence.

We’re dedicated to fostering growth through collaboration, powered by bold thinking, teamwork, and the passion of our people.

Here, you’ll:

• Move fast and embrace change
• Always look for better ways
• Grow, thrive, and help shape what’s next

Join us and be part of a culture where you can make an impact while building your future.

What You’ll Do:

• Adjust all suspected SIU/Fraud Personal Lines Claims. This may include field adjusting tasks.
• Manage weekly rescission meetings. Review claims to determine if more information is needed, create and send denial letters when PL Underwriting and Legal agree that the policy will be rescinded.
• Run all background checks for Personal and Commercial lines claims. Provide comprehensive reports to the assigned PL or CL claim examiner.
• Manage suspect jewelers and handle Personal Lines claims when these jewelers are assigned. This includes adding claims to the jeweler monitoring list, working with JIAP, Jewelers Solutions and Strategic partners teams to address concerns about a particular jeweler.
• Identify fraudulent appraisals and suspect appraisers.
• Manage relationships with ISO/Verisk, NICB, Skopenow, Lexis Nexis, Allied Universal. This includes working with these vendors system upgrades and integrations.
• Manage and report state fraud referrals for PL & CL Claims. Create a quarterly report that includes line of business, number of referrals, location of insureds, etc.
• Manage file requests from other carriers through NICB and Allied Universal for PL & CL Claims.
• Manage request of files for PL & CL Claims through NICB and Allied Universal.
• Manage and evaluate field vendors, including investigators and adjusters.
• Create an SIU process for managing and tracking SIU claims including jewelers that may be involved. This includes using data such as AI to identify potential fraud on part of the insured or jeweler. Use data and AI to identify potential fraud rings in Personal Lines claims.
• Work with Jewelers Security Alliance to report and investigate suspected fraud.
• Manage and facilitate yearly SIU training.
• Provide input on reports, data, and bordereaux’s to TPA Cover holder
• Other duties as assigned

PRINCIPAL WORKING RELATIONSHIPS

• Internal: Claims staff, Personal and Commercial Lines Underwriting, Jeweler Solutions, Strategic Partners, JIAP, Asset protection
• External: JM policyholders, jewelers, SIU vendors, adjusters, attorneys, underwriters, & JSA.

What You’ll Bring:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

COMPETENCIES

• Attention to detail, precise recordkeeping
• Team player
• Can build a strong relationship with agents and/or customers
• Ask questions and communicate clearly
• Contributes to exceptional customer experience
• Initiative to act without being prompted
• Sound decision making
• Organized, understands prioritization, and meets deadlines
• Financial and business acumen
• Ability to remain flexible
• Actively seeking professional development
• Embraces and leads change

EDUCATION AND/OR EXPERIENCE

• Bachelor’s degree preferred.
• 3-5 years of relevant SIU/fraud claims handling experience preferred.
• Prior P&C claims adjusting experience required. Must have knowledge of claims processes, practices, and coverage.
• Professional insurance designations such as CPCU, SCLA, AIC and or a fraud designation preferred.

COMPUTER SKILLS

• Proficient in Guidewire, Microsoft suite applications including Word, Excel, Outlook, and PowerPoint.

PHYSICAL REQUIREMENTS

• Prolonged periods sitting at a desk and working on a computer.
• Occasionally required to stand; walk; use hands to finger, handle, or touch objects or controls; and talk or hear.

What We Offer You:

• Competitive Compensation & Benefits: Includes performance bonuses, generous paid time off, and a top-tier retirement program with 401(k) matching and additional company contributions.
• Collaborative Culture: Work alongside talented, passionate peers who value ownership and continuous learning.
• Community & Giving: Benefit from 50% charitable gift matching and paid volunteer time to support nonprofit causes
• Great Place to Work® Certified: Join a team recognized for an environment of innovation and growth.

Accessibility and Accommodations
We are committed to providing an inclusive and accessible recruitment process. If you require accommodation at any stage of the application or interview process, please let us know by contacting jmrecruiting@jminsure.com.