Senior SIU Investigator

The salary range for this job posting is $61,742.00 - $ annually + bonus + benefits.

Pay Type:

Salary. The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process.

Encova Insurance is seeking a Senior SIU Investigator. This role will be home-based. We strongly prefer you to reside in Pennsylvania but we will consider other well qualified candidates within our payroll footprint. This role will report to the Manager, Special Investigations.

This role can be hired at either the SIU Investigator or Senior SIU investigator level and compensation range shown includes both job levels. Job description is listed for the senior level role.

Are you a Referral?

If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team.

Unique residence requirements are listed in each job posting, please review closely for details.

Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes:

Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin.

The SIU investigator is responsible for the review, acceptance, action planning, investigation and documentation of suspect claims. The SIU investigator is the subject matter expert on insurance fraud and communicates directly with all levels of claims personnel with regard to investigative strategies and conclusions. The SIU investigator is responsible for fraud recognition training for claims personnel and agents and provides administrative record keeping on suspicious claim fraud for management, law enforcement, and resolution specialists.

• Review referred suspicious claims and identify the scope of investigation needed (full, limited or no investigation required) and provide feedback to the resolution specialist as needed on how to resolve the suspect issues in the claim.
• Investigate assigned suspicious claims.
• Determine and interview all parties who are material to the investigation.
• Independently perform investigative fieldwork to verify information and/or investigative leads.
• Utilize appropriate databases, informational resources and public records to verify information and/or investigative leads.
• Assign and oversee investigative vendors that are necessary for a thorough investigation including managing budgets and reports.
• Identify and communicate relevant coverage issues during the course of the investigation.
• Independently analyze data and facts to develop action plans and provide investigative conclusions.
• Perform other investigation and analysis as needed based on the requirements of the claim assignment.
• Prepare complete, detailed, and accurate narrative investigation reports, periodic status reports, and final opinions.
• Assist in the mentoring, development and providing of technical direction to other SIU investigators.
• Develop and mentor claims personnel regarding insurance fraud issues.
• Develop and coordinate training for SIU investigators in all phases of the investigation process.
• Work closely and communicate effectively with resolution specialists and claims leadership.
• Assist with fraud recognition training for resolution specialists and agents.
• Keep statistical data for transfer into SIU database and assist in developing data collection methods.
• Assist with and participate in examinations under oath.
• Review investigative results with resolution specialists and leadership before the claim is resolved.
• Appear in court as a company representative when needed.
• Represent SIU during claim reviews when needed.
• Assist in development of SIU field investigation standards and procedures.
• Generate and submit fraud reports to insurance departments.
• As directed by the SIU manager, may act as the department manager in the absence of the SIU manager.

Note: The SIU investigator is responsible for SIU investigations only. Resolution specialists are responsible for handling the claim including determining the amount of loss and negotiating settlements.

• Complete various special projects and investigations as assigned.
• Network with industry personnel, law enforcement, legal counsel and others to develop information for…