Director, Special Investigations Unit (Remote)

Description

Key Responsibilities

• Develop and execute enterprise SIU strategy to detect, investigate, and prevent insurance fraud.
• Monitor emerging fraud schemes and industry trends to proactively strengthen detection capabilities.
• Lead and manage SIU investigators, SIU 1099s, Field Investigators, and vendors while establishing performance expectations and KPIs.
• Conduct regular performance reviews of the SIU staff ensuring quality service standards are being met.

• Direct investigations into suspected fraud across workers’ compensation, liability, property, casualty, and disability claims.
• Ensure investigations meet company quality standards, regulatory standards, and evidentiary requirements.
• Review investigation findings, reports, and approve referrals to law enforcement or regulatory bodies.
• Collaborate with legal teams on litigation support, depositions, and fraud prosecution efforts.

• Ensure compliance with state insurance fraud regulations, reporting requirements, and anti-fraud plans.
• Maintain policies, SOPs, and training programs aligned with regulatory guidelines and industry standards.

• Utilize predictive analytics, claims data mining, and external fraud databases (e.g., ISO, NICB).
• Identify high-risk claims trends and coordinate fraud prevention initiatives with claims leadership.
• Assist leadership as needed with implementing technology and automation to improve investigation efficiency and case outcomes.

• Partner with claims, underwriting, legal, compliance, and audit teams to identify fraud indicators.
• Maintain relationships with law enforcement, regulatory bodies, and industry fraud networks as needed.
• Represent the organization in fraud task forces, industry groups, and regulatory meetings as needed.

Skills, knowledge & expertise

• 8–12+ years of insurance claims or fraud investigation experience.
• 5+ years leadership experience managing SIU or fraud investigation teams.
• Bachelor’s degree in Criminal Justice, Insurance, Risk Management, or related field preferred.
• Knowledge of insurance fraud statutes and regulatory compliance requirements.
• Experience leading complex fraud investigations and litigation support.
• Certified Fraud Examiner (CFE) preferred.
• Certified Insurance Fraud Investigator (CIFI) preferred.
• Prior law enforcement or investigative background preferred.
• Experience in workers’ compensation, casualty, or liability investigations preferred.

Equal Employment Opportunity & Legal Notices

• Medical, dental, and vision plans to support your health and that of your family
• A 401(k) plan with employer matching
• Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
• Paid holidays
• Life insurance and short‑term and long‑term disability coverage

About Davies