SIU Desk Investigator - Miami

Job Summary

A Special Investigations Unit (SIU) Desk Investigator within an insurance company plays a crucial role in assisting the SIU and claims departments with fraudulent activities related to insurance claims. The Desk Investigator conducts low to moderate investigations involving suspicions of insurance fraud related to the application of insurance, auto/property, and injury claims. The Desk Investigator plans, prioritizes, and executes investigative assignments, including backgrounds, interviews, and Examinations Under Oath. The Investigator is responsible for analytical review of suspicious claims utilizing various investigative methods and techniques. The investigator must evaluate relevant information essential in resolving suspicious and complex investigations. This position requires demonstrated effectiveness in the understanding and application of legal and claim principles. The Investigator should have a working understanding of coverage and/or personal injury protection coverage.

Job Responsibilities

• Conducts Examinations Under Oath, and reports the findings of same.
• Claims Investigations to include but not limited to: statements, document analysis/verification, damage analysis.
• Provides office training to ensure recognition of potentially suspicious or fraudulent files in the branch.
• Maintains compliance with industry and company policies.
• Understands regulatory / statutory requirements; develops and maintains knowledge of changes in law both at state and national levels.
• Utilizes our claims and other various systems properly.
• Attends industry meetings to identify industry trends.
• Completes individual weekly Investigator report to manager.
• Attends and participates in team meetings, roundtables.
• Actively affiliates and maintains network of SIU, claims, law enforcement, attorney, and related contacts to ensure investigation methods are current and proper operating procedures are utilized.
• Meets individual goals and objectives.
• Maintains consistent, fair, and diplomatic interactions with co-workers.
• Performs other duties as assigned by SIU Manager.

Requirements

• Formal Education & Certification: Bachelor's degree in criminal justice, finance, business administration, or related field. Previous experience in insurance claims investigation, fraud detection, or law enforcement helpful.
• Excellent communication and interpersonal skills, with the ability to interact effectively with diverse stakeholders.
• Attention to detail and ability to maintain confidentiality when handling sensitive information.
• Proficiency in relevant software applications for data analysis and documentation.
• Knowledge of insurance laws, regulations, and industry standards related to fraud investigation.
• Knowledge in medical terminology, medical billing, CMS 1500 forms helpful.
• Florida Insurance Adjusters License required within 90 days of employment.
• Experience: 2 years of prior SIU Investigator or claims handling experience. Must have a working understanding of coverage and requirements of personal auto policies and or personal injury protection coverage.

Skills & Competencies

• Insurance Knowledge: A solid understanding of insurance principles, policies, and regulations is fundamental. This includes familiarity with different types of insurance (e.g., property, casualty, life), underwriting practices, and claims processing procedures.
• Attention to Detail: Insurance analysis often involves reviewing large volumes of information, such as policy terms, coverage limits, and claim documentation. Attention to detail is essential to identify discrepancies, errors, or inconsistencies that could impact insurance outcomes.
• Organizational Skills: Ability to manage multiple cases and prioritize tasks.
• Problem-Solving Abilities: Insurance analysts frequently encounter challenging scenarios that require creative problem-solving skills. You should be adept at identifying issues, considering alternative solutions, and making sound recommendations to mitigate risks or resolve disputes.
• Communication Skills: Strong verbal and written communication skills are essential for conveying complex insurance concepts to clients, colleagues, and stakeholders. You should be able to explain insurance policies, procedures, and recommendations clearly and concisely.
• Interviewing Skills: Proficiency in conducting effective interviews.
• Customer Service Orientation: Providing excellent customer service is paramount in the insurance industry. Whether you're assisting clients with policy inquiries or addressing claim concerns, a customer-centric approach is vital to building trust and satisfaction.
• Ethical Conduct: Integrity and ethical behavior are foundational principles in the insurance profession. Insurance analysts must adhere to industry regulations, confidentiality standards, and professional codes of conduct to maintain trust and credibility.
• Adaptability: The insurance landscape is continually evolving due to changes in regulations, market conditions, and emerging risks. Being adaptable and open to learning new concepts or technologies is essential for staying relevant and effective in your role.
• Teamwork and Collaboration: Insurance analysis often involves collaboration with underwriters, actuaries, claims adjusters, and other professionals within the insurance company. The ability to work effectively as part of a team, share insights, and leverage collective expertise is key to achieving organizational goals.
• Time Management: Managing multiple tasks, deadlines, and priorities is common in insurance analysis roles. Effective time management skills, including prioritization, organization, and task delegation, are essential for maximizing productivity and meeting performance expectations.
• Continuous Learning: The insurance industry is dynamic, with new products, technologies, and regulations shaping the landscape. A commitment to continuous learning, whether through professional development courses, industry certifications, or networking opportunities, is essential for career growth and staying ahead of industry trends.