Job Description

Special Investigations Unit (Siu) Desk Investigator

At AssuranceAmerica, we are more than a unique blend of insurance assets. We believe in creating a culture where every associate has the opportunity to learn and grow. We strive to create a work environment to meet associate needs, and we are determined to achieve excellence in everything we do.

This is an opportunity to join a dynamic team in a company that is a leader in the non-standard auto insurance space and functions with a small company, entrepreneurial style. This position will require someone with an understanding that one needs to have a "roll up your sleeves" attitude to help make things happen.

Job Summary

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. The Investigator should have a working understanding of coverage and/or personal injury protection coverage.

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.

Job Responsibilities

• The primary role of the desk investigator will be to conduct Examinations Under Oath, and report the findings of same.
• Claims Investigations to include but not limited to: statements, document analysis/verification, damage analysis
• Provides office training to ensure recognition of potentially suspicious or fraudulent files in the branch
• Must ensure compliance with industry and company policies
• Must understand regulatory / statutory requirements; develops and maintains knowledge of changes in law both at state and national levels
• Properly utilizes our claims and other various systems
• Attends industry meetings to identify industry trends
• Completes individual weekly Investigator report to manager
• Attends and participates in team meetings, roundtables
• Actively affiliates and maintains network of SIU, claims, law enforcement, attorney, and related contacts to ensure investigation methods are current and proper operating procedures are utilized
• Responsible for meeting individual goals and objectives
• Maintains consistent, fair, and diplomatic interactions with co-workers
• Performs other duties as assigned by SIU Manager

Formal Education & Certification

• Bachelor's degree in criminal justice, finance, business administration, or related field.
• Previous experience in insurance claims investigation, fraud detection, or law enforcement helpful.
• 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.
• Knowledge in medical terminology, medical billing, CMS 1500 forms helpful
• Florida Insurance Adjusters License required within 90 days of employment

Experience

2 years of prior SIU Investigator or claims handling experience. Must have a working understanding of coverage and requirements of personal auto policies and or personal injury protection coverage.

Skills & Competencies

• Insurance Knowledge: A solid understanding of insurance principles, policies, and regulations is fundamental. This includes familiarity with different types of insurance (e.g., property, casualty, life), underwriting practices, and claims processing procedures.
• Attention to Detail: Insurance analysis often involves reviewing large volumes of information, such as policy terms, coverage limits, and claim documentation. Attention to detail is essential to identify discrepancies, errors, or inconsistencies that could impact insurance outcomes.
• Organizational Skills: Ability to manage multiple cases and prioritize tasks.
• Problem-Solving Abilities: Insurance analysts frequently encounter challenging scenarios that require creative problem-solving skills. You should be adept at identifying issues, considering alternative solutions, and making sound recommendations to mitigate risks or resolve disputes.
• Communication Skills: Strong verbal and written communication skills are essential for conveying complex insurance concepts to clients, colleagues, and stakeholders. You should be able to explain insurance policies, procedures, and recommendations clearly and concisely.
• Interviewing Skills: Proficiency in conducting effective interviews.
• Customer Service Orientation: Providing excellent customer service is paramount in the insurance industry. Whether you're assisting clients with policy inquiries or addressing claim concerns, a customer-centric approach is vital to building trust and satisfaction.
• Ethical Conduct: Integrity and ethical behavior are foundational principles in the insurance profession. Insurance analysts must adhere to industry regulations, confidentiality standards, and professional codes of conduct to maintain trust and credibility.
• Adaptability: The insurance landscape is continually evolving due to changes in regulations, market conditions, and emerging risks. Being adaptable and open to learning new concepts or technologies is essential for staying relevant and effective in your role.
• Teamwork and Collaboration: Insurance analysis often involves collaboration with underwriters, actuaries, claims adjusters, and other professionals within the insurance company. The ability to work effectively as part of a team, share insights, and leverage collective expertise is key to achieving organizational goals.
• Time Management: Managing multiple tasks, deadlines, and priorities is common in insurance analysis roles. Effective time management skills, including prioritization, organization, and task delegation, are essential for maximizing productivity and meeting performance expectations.
• Continuous Learning: The insurance industry is dynamic, with new products, technologies, and regulations shaping the landscape. A commitment to continuous learning, whether through professional development courses, industry certifications, or networking opportunities, is essential for career growth and staying ahead of industry trends.

This job description indicates the essential responsibilities of the job. The duties described are not to be interpreted as being all-inclusive to any specific associate. Management reserves the right to add to, modify, or change the work assignments of the position as business needs dictate. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This job description does not represent a contract of employment. Employment with AssuranceAmerica is at-will. The at-will relationship can be terminated at any time, with or without reason or notice by either the employer or the associate.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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