SIU Investigator - San Jose, CA
SIU Investigator - San Jose, CA
Location: North America
City: San Jose, CA
Job Type: FT
GlobalOptions, an international investigative firm servicing the insurance, government, and legal communities is currently seeking an experienced SIU investigator to join our team. We perform surveillance, activity checks, and background investigations on worker's compensation, auto liability, general liability, and long and short term disability claims. Assignments will be throughout the San Jose, CA area. This is a full time position offering dental, vision, holiday pay, paid time off and matching 401K benefits.
The SIU investigator will conduct red flag file reviews, claim file evaluations and field investigations to investigate and document suspected fraudulent activity related to insurance claims. Prepare SIU evaluation reports, updates, state mandated reporting forms and documented fraud referrals. Obtain, document and organize evidence that is suitable for presentation in a court of law to establish the presence of material misrepresentations. Educate claims staff regarding insurance fraud, red flags and the SIU process. Applicants must be familiar with the claims processes for multiple lines of insurance business including workers’ compensation, general liability, automotive and property claims. Three to five years investigating insurance claims is a must. Make recommendations to claims staff to ensure insurance fraud is properly identified and to promote claims savings through the application of investigative best practices. Provide in service training, including annual antifraud training, to claims staff.
SIU investigators are required to work a varying schedule including nights, weekends and holidays. We are looking for applicants with Bachelor's degree (B.S./B.A. in Criminal Justice, Business or related field) from four-year college/ university and at least three years of experience conducting client facing activities and three years of experience as a full time investigator assigned to a carrier or contract SIU.
- Educate claims staff regarding red flags and the identification of insurance fraud as it relates to their line of business, workers’ compensation, general liability, auto and property.
- Conduct verbal consultations with adjusters to discuss suspected fraudulent claim activity and assist in the identification of industry accepted red flags.
- Complete red flag file reviews, claim file evaluations, investigative updates, state mandated reporting forms and documented fraud referrals.
- Identify and articulate red flags, suspected fraudulent activity, material misrepresentations and other indicators of insurance fraud.
- Educate claims staff via in service training and verbal consultations to promote awareness of insurance fraud, industry accepted red flags, the SIU process and investigative best practices.
- Make sound investigative recommendations to claims staff that will assist in the identification and investigation of insurance fraud and promote claims savings.
- Coordinate investigations of suspected fraudulent activity with GlobalOptions’ investigators, case managers, 3rd party vendors and prosecuting authorities.
- Obtain, document and report statistical information related to suspected fraudulent activity, red flags, state mandated reporting, arrests, convictions, sentencing, restitution and claims savings.
- Establish appointments to conduct field investigations within established timeframes.
- Conduct interviews and obtain recorded statements from a wide variety of individuals in varying environments.
- Obtain supporting documentation including claim documents, releases and other records.
- Document all investigative efforts and case related communication in GlobalTrak case notes.
- Complete expense reports on a bi-weekly or monthly basis.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Operate a motor vehicle in a safe manner.
- Operate a digital audio recorder in a manner that produces evidence that can be presented in a court of law.
- Operate a computer and related software to complete daily reports, evidence transfers, timesheets and expenses.
- Read claim file documents including but not limited to, medical reports, investigative reports deposition transcripts, correspondences and claim payment histories.
- Write investigative reports in a clear and concise manner utilizing proper grammar and spelling.
- Communicate with staff and clients in a professional manner.
- Ability to travel to and from assignments on a daily basis.
- Bachelor's degree (B.S./B.A. in Criminal Justice, Business or related field) from four-year college/ university
- Three years of experience conducting client facing activities
- Three years of experience as a full time investigator assigned to a carrier or contract SIU
Certificates and Licenses:
- Current Driver's License
- Current Private Investigator's License (where applicable)
- Full coverage automobile insurance
To apply for this position, please send your contact information along with a cover letter and resume to: firstname.lastname@example.org
We are an Equal Opportunity Employer.