SIU Manager

Responsibilities

• Assist with leading anti-fraud efforts across commercial and personal lines of business.
• Oversee a team of investigators and support specialists, ensuring high performance and adherence to best practices.
• Execute a strategic vision for fraud detection and prevention across all lines of business.
• Establish and monitor key performance indicators (KPIs) to measure the effectiveness of the SIU program.
• Collaborate with senior leadership to align SIU goals with broader organizational objectives.
• Lead, mentor, and manage a team of SIU investigators and support specialists.
• Oversee the intake, triage, and assignment of suspected fraudulent claims.
• Direct the investigation of complex, high-value, or sensitive cases involving potential fraud, collusion, staged losses, or organized crime.
• Ensure investigative activities are conducted in accordance with legal standards, company policies, and industry best practices.
• Review and approve investigative reports, summaries, and referrals to law enforcement or regulatory bodies.
• Manage and implement a comprehensive quality assurance program to evaluate the accuracy, completeness, and compliance of SIU investigations.
• Conduct regular audits of investigative files to ensure adherence to internal protocols, regulatory requirements, and industry standards.
• Provide feedback and coaching to investigators based on audit findings to drive continuous improvement.
• Monitor trends in investigative performance and develop targeted training or process enhancements as needed.
• Ensure timely and accurate reporting to state fraud bureaus, the NICB, and other regulatory entities.
• Ensure compliance with all applicable state and federal regulations, including mandatory fraud reporting requirements.
• Maintain accurate and timely documentation of all investigative activities in the case management system.
• Prepare and submit regulatory reports, internal dashboards, and executive summaries as required to SIU Leadership.
• Serve as a primary liaison with state fraud bureaus, the National Insurance Crime Bureau (NICB), and other external agencies.
• Partner with claims, underwriting, legal, and risk management teams to identify fraud trends and vulnerabilities.
• Provide training and guidance to claims staff on fraud indicators, red flags, and referral procedures.
• Represent the company at industry conferences, fraud task forces, and professional associations.
• Leverage data analytics, predictive modeling, and fraud detection software to enhance investigative capabilities.
• Evaluate and implement new tools and technologies to improve SIU efficiency and effectiveness.

Qualifications

• Minimum of 7–10 years of experience in insurance fraud investigations, with minimum of 3 years in a supervisory or managerial role.
• Extensive knowledge of commercial and personal insurance products and claims processes.
• Completion of one or more of the following designations: Fraud Claims Law Specialist (FCLS), Certified Insurance Fraud Investigator (CIFI), Certified Fraud Examiner (CFE), Chartered Property Casualty Underwriter (CPCU), Associate in Claims (AIC).
• Bachelor’s degree in Criminal Justice, Insurance, Business Administration, or a related field.