SIU Investigator

Ascendant Claims Services LLC, (an affiliate of Ascendant Commercial Insurance Inc.), is a third party claims administrator committed to providing best in class claims adjudication solutions. Excellence and professionalism in serving the needs of our agents and insureds is Ascendant’s core operating philosophy.

Ascendant is looking for the next generation of Special Investigations Unit Investigators! If you’re looking for a company that offers stability, great benefits and compensation; with a strong emphasis on values, integrity, employee relations, and customer service then apply today to find out how you can become a dynamic part of Ascendant's S.I.U. team!

Primary responsibilities include but are not limited to effectively managing an inventory of suspected fraudulent claims across PIP, Workers Compensation, and Auto Comprehensive lines pursuant to statutory regulations as well as Claims Best Practices standards. The SIU Investigator will conduct thorough investigations, including recorded statements and scene inspections, and manage third party SIU vendors with a primary focus on surveillance operations. The SIU Investigator will develop strategic investigative plans that are efficient, cost effective, and executed in a timely manner to mitigate risk exposure to the company.

Resposibilities:

• Conduct comprehensive investigations of suspected fraudulent claims, staged accidents, and suspicious losses.
• Secure recorded statements from claimants, insureds, witnesses, and other relevant parties to assess inconsistencies and identify fraud indicators.
• Review claim files, medical records, billing documentation, and loss details to detect patterns of potential fraud and misrepresentation.
• Coordinate and manage third party SIU vendors, with a primary focus on surveillance operations, ensuring proper case direction, quality results, and cost control.
• Analyze surveillance footage, background investigations, and investigative findings to determine claim legitimacy and support claim decisions.
• Prepare detailed investigative reports summarizing findings, evidence, and recommendations for claim handling or denial.
• Identify and document red flags, refer cases for further action when appropriate, and support claims and legal teams with investigative findings.
• Ensure all investigations comply with applicable state regulations, insurance laws, and internal Claims Best Practices.
• Maintain accurate and timely case documentation within claim and SIU systems.
• Manage an assigned caseload efficiently, ensuring all investigations are completed in a timely and organized manner.
• Assist with special investigations, projects, or initiatives as directed by management.

Our S.I.U Field Representative should possess the following:

• Be well versed in aspects of S.I.U investigations, self-motivated, organized and able to handle a voluminous case load while conducting multiple field investigations.
• Bilingual ( preferred )

The SIU Investigator will effectively manage an inventory of suspected fraudulent claims across PIP, Workers Compensation, and Auto Comprehensive lines pursuant to statutory regulations as well as Claims Best Practices standards. The SIU Investigator will conduct thorough investigations, including recorded statements and scene inspections, and manage third party SIU vendors with a primary focus on surveillance operations. The SIU Investigator will develop strategic investigative plans that are efficient, cost effective, and executed in a timely manner to mitigate risk exposure to the company.

Responsibilities

• Conduct comprehensive investigations of suspected fraudulent claims, staged accidents, and suspicious losses.
• Secure recorded statements from claimants, insureds, witnesses, and other relevant parties to assess inconsistencies and identify fraud indicators.
• Review claim files, medical records, billing documentation, and loss details to detect patterns of potential fraud and misrepresentation.
• Coordinate and manage third party SIU vendors, with a primary focus on surveillance operations, ensuring proper case direction, quality results, and cost control.
• Analyze surveillance footage, background investigations, and investigative findings to determine claim legitimacy and support claim decisions.
• Prepare detailed investigative reports summarizing findings, evidence, and recommendations for claim handling or denial.
• Identify and document red flags, refer cases for further action when appropriate, and support claims and legal teams with investigative findings.
• Ensure all investigations comply with applicable state regulations, insurance laws, and internal Claims Best Practices.
• Maintain accurate and timely case documentation within claim and SIU systems.
• Manage an assigned caseload efficiently, ensuring all investigations are completed in a timely and organized manner.
• Assist with special investigations, projects, or initiatives as directed by management.

Required Skills

• Minimum 5 years of SIU, insurance investigations, or related investigative experience (Florida experience preferred).
• Strong knowledge of insurance fraud schemes, particularly involving PIP, Workers’ Compensation, and Auto claims.
• Experience directing and reviewing surveillance operations and working with third-party investigative vendors.
• Ability to analyze complex claim files, identify fraud indicators, and draw logical, evidence-based conclusions.
• Strong understanding of investigative techniques, statement taking, and evidence handling.
• Familiarity with Florida insurance regulations and fraud reporting requirements (DFS referral process, etc.).
• Excellent written and verbal communication skills, including preparation of detailed investigative reports.
• Strong organizational and time management skills with the ability to handle multiple investigations simultaneously.
• Ability to work independently with minimal supervision and make sound investigative decisions.
• Proficient in computer systems, case management platforms, and Microsoft Office applications.
• Strong critical thinking and analytical problem-solving skills.
• Ability to collaborate effectively with claims staff and contribute to overall risk mitigation efforts.

Job Type: Full-time

Pay: $65,000.00 - $75,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Opportunities for advancement
• Paid time off
• Vision insurance

Application Question(s):

• How many years of experience do you have working in Special Investigation Unit for an insurance company?
• Do you have knowledge of insurance fraud schemes, particularly involving PIP, Workers’ Compensation, and Auto claims?

Language:

• English (Required)
• Spanish (Required)