Internal Major Case SIU Investigator

About the Role

Under general supervision, investigates large-scale complex and highly organized major cases across multiple jurisdictions that involve fraud or other conversion of company assets.

Essential Functions

• Conducts investigations into large-scale and highly organized major cases involving large numbers of claims across multiple jurisdictions with significant loss exposure and suspected fraud or other suspicious activities against the company.
• Coordinates investigative assets to record reviews and conduct field investigations, canvasses and surveillance when necessary.
• Analyzes high-level, complex fraud schemes for possible litigation under the Racketeering Influenced and Corrupt Organization Act or for referral to appropriate federal, state or local law enforcement or regulatory review.
• Conducts background and database searches and reviews digital and documentary evidence to support the development of major cases.
• Uses information resources to gather, analyze and evaluate information to determine its credibility and applicability to fraud investigations.
• Investigates statistically significant trends in claims and underwriting data to identify emerging or evolving fraud schemes.
• Presents findings and recommendations to senior management.
• Collaborates with the NICB, regulators, law enforcement and fee counsel on investigations.
• Assists external agencies in documentation gathering to support civil prosecution and/or affirmative litigation cases.
• Provides training and support to other SIU major case investigators in the identification of activity involving medical providers, body shops, glass harvesters, and broker fraud.
• Trains and advises line, staff and management in security controls and outlines gaps in current protocols and procedures.
• Adheres to the Code of Conduct, company policies, and operating principles.
• Meets attendance standard at business location to perform necessary job functions and to facilitate interaction with management and co-workers.

Requirements

• Must be able to, with or without accommodation, perform the essential functions which include, but are not limited to seeing, hearing, typing and speaking.
• Must be able to work both independently and in a team environment.
• Must be able to multi-task.
• Must be able to learn and apply large amounts of technical and procedural information.
• Must be able to communicate effectively verbally and in writing.

Culture & Development

• Great Company: Protecting customers through life's twists and turns with innovation and integrity.
• Great Careers: Personalized development programs, mentorship, and certification assistance.
• Great Culture: Inclusive and collaborative culture rooted in shared success.
• Great Rewards: Competitive pay, benefits, and flexibility to support your well-being and future.