Conduct timely investigations, including recorded statements and interviews of claimants, witnesses, and employers
Provide timely status updates to the case manager and client
Document claim files clearly, accurately, and promptly
Maintain confidentiality and professionalism
Develop appropriate investigative action plans
Ensure accuracy, quality, and timeliness of evidence and compliance with applicable laws, legal codes, and governing agencies
Provide claim adjusters with investigation results and document findings
Determine whether additional evidence is required, including accident reports, scene reconstructions, witness statements, police reports, and expert opinions
Provide recommendations and decisions regarding investigative efforts
Perform detailed database queries and analyze and organize critical SIU investigation data
Evaluate state compliance referrals when questionable or suspicious activity is identified
Maintain active membership in professional organizations providing SIU assistance and resources
Establish and maintain relationships with law enforcement, government regulatory agencies, and insurance industry personnel
Requirements:
Extensive experience with claims across insurance lines, especially Workers’ Compensation claims
Strong investigative skills
Detail-oriented
Ability to recognize patterns of inconsistencies linked to fraudulent activity
Ability to interact with clients, repair shops, appraisers, and employers
Ability to work independently
Excellent verbal and written communication skills
Good organization and time-management skills
Knowledge of tools and techniques for insurance claims investigations
Proficiency with Word, Excel, Outlook, and Teams
Laptop computer, cell phone, audio recording device with download capability, digital camera, and tape measure
CFE or FCLS designations preferred
5–10 years of claims and SIU investigation experience preferred