SIU Investigator
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Job Description
SIU Investigator conducting Workers’ Compensation and other insurance-claim fraud investigations for Delta Group. Interviewing claimants and witnesses, analyzing evidence, and reporting findings to insurers and clients.
Responsibilities:
- 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
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