SIU Desk Investigator - Miami

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. This is an in-office position, and only candidates residing in Miami-Dade County will be considered. Relocation assistance is not available for this position.

Responsibilities

Conduct Examinations Under Oath and report the findings; Conduct claims investigations including statements, document analysis/verification, and damage analysis; Provide office training to ensure recognition of potentially suspicious or fraudulent files in the branch; Ensure compliance with industry and company policies; Understand regulatory/statutory requirements and maintain knowledge of changes in law at state and national levels; Properly utilize claims and other various systems; Attend industry meetings to identify industry trends; Complete individual weekly Investigator report to manager; Attend and participate in team meetings and roundtables; Actively maintain a network of SIU, claims, law enforcement, attorney, and related contacts; Meet individual goals and objectives; Maintain consistent, fair, and diplomatic interactions with co-workers; Perform other duties as assigned by SIU Manager; Plan, prioritize, and execute investigative assignments including backgrounds, interviews, and Examinations Under Oath; Perform analytical review of suspicious claims using various investigative methods and techniques

Requirements

Bachelor's degree in criminal justice, finance, business administration, or related field; 2 years of prior SIU Investigator or claims handling experience; Working understanding of coverage and requirements of personal auto policies and/or personal injury protection coverage; 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; Florida Insurance Adjusters License required within 90 days of employment

Nice to have

Previous experience in insurance claims investigation, fraud detection, or law enforcement; Knowledge in medical terminology, medical billing, CMS 1500 forms; Understanding of coverage and requirements of personal auto policies and/or personal injury protection coverage