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SIU Field Investigator Senior

Job Description

Primary Purpose:

Identify and investigate questionable claims/risks and deliver facts and assistance to internal and external customers. Provides investigative assistance within the region and technical direction and support with complex SIU investigations

Essential Duties and Responsibilities:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.


  • Assist SIU manager with duties to include special projects

  • Establish an investigative plan on a daily basis

  • Receive referral, communicate with referring sources, verify need for investigation and document all appropriate information

  • Initiate investigation by gathering facts and evidence with all interested parties

  • Complete appropriate reports

  • Run appropriate database checks

  • Take recorded statements when necessary

  • Netmap referrals as necessary

  • Hire appropriate experts with coordination of claim rep and supervisor and document investigative activity

  • Complete both inside and field investigative tasks

  • Work with vendors in setting expectations and resolving questions raised through the investigation

  • Track and document the quality of service provided by defense counsel and forensic experts and manage vendor costs

  • Evaluate facts and determine applicable laws

  • Determine state fraud reporting requirements; summarization of investigative findings

  • Identify answers to more complex issues with insurance law by reading and interpreting case law

  • Provide training to internal and external customers

  • Serve as mentor to SIU field investigators

  • Periodic audit review of files by supervisor or management

  • Conducts internal investigations regarding defalcation and employee misconduct issues as assigned


Minimum Skills and Competencies:

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.


  • Bachelor's Degree or in-lieu of degree equivalent education, training and work-related experience

  • Possess a solid understanding of insurance law as it relates to claims and SIU files

  • Ability to interpret and apply investigative findings to determine action plan

  • Possess effective verbal and written communication skills

  • Ability to successfully perform in a high-energy, dynamic and team-oriented environment

  • Possess effective organization and time management skills with the ability to work under pressure and adhere to project deadlines

  • Possess excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization

  • Ability to demonstrate integrity within a professional environment

  • High degree of initiative, mature judgment, and discretion

  • Ability to handle confidential information in a professional manner

  • Possess a general understanding of the insurance industry, organizational relationships of the company and the functions of other departments such as Policy Operations and Marketing

  • Ability to manage conflict resolution

  • Ability to travel up to 10%


Desired Skills:


  • 7+ years of experience with a law enforcement agency and/or multi-line claims handling experience within the insurance industries

  • Possess prior experience in the investigation of insurance fraud

  • Successful completion of one or more professional designations: FCLS (Fraud Claims Law Specialist), CFE (Certified Fraud Examiner), CIFI (Certified Insurance Fraud Investigator)

  • Higher Educational Degree (Master's Degree)

Job Requirements

 

Job Snapshot

Location US-CA-Sacramento
Employment Type Full-Time Employee
Pay Type Year
Pay Rate N/A
Store Type Insurance
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Company Overview

National General Insurance

National General Insurance Group is one of the largest automobile insurers in the United States. National General Insurance Group offers property and casualty products, including personal auto, RV, motorcycle, commercial auto and more. With a nationwide network of claims professionals and a 24-hour, toll-free claims hotline available 365 days a year, National General Insurance provides superior claims service for its customers. Learn More

Contact Information

US-CA-Sacramento
National General Insurance
Snapshot
National General Insurance
Company:
US-CA-Sacramento
Location:
Full-Time Employee
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Insurance
Store Type:

Job Description

Primary Purpose:

Identify and investigate questionable claims/risks and deliver facts and assistance to internal and external customers. Provides investigative assistance within the region and technical direction and support with complex SIU investigations

Essential Duties and Responsibilities:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.


  • Assist SIU manager with duties to include special projects

  • Establish an investigative plan on a daily basis

  • Receive referral, communicate with referring sources, verify need for investigation and document all appropriate information

  • Initiate investigation by gathering facts and evidence with all interested parties

  • Complete appropriate reports

  • Run appropriate database checks

  • Take recorded statements when necessary

  • Netmap referrals as necessary

  • Hire appropriate experts with coordination of claim rep and supervisor and document investigative activity

  • Complete both inside and field investigative tasks

  • Work with vendors in setting expectations and resolving questions raised through the investigation

  • Track and document the quality of service provided by defense counsel and forensic experts and manage vendor costs

  • Evaluate facts and determine applicable laws

  • Determine state fraud reporting requirements; summarization of investigative findings

  • Identify answers to more complex issues with insurance law by reading and interpreting case law

  • Provide training to internal and external customers

  • Serve as mentor to SIU field investigators

  • Periodic audit review of files by supervisor or management

  • Conducts internal investigations regarding defalcation and employee misconduct issues as assigned


Minimum Skills and Competencies:

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.


  • Bachelor's Degree or in-lieu of degree equivalent education, training and work-related experience

  • Possess a solid understanding of insurance law as it relates to claims and SIU files

  • Ability to interpret and apply investigative findings to determine action plan

  • Possess effective verbal and written communication skills

  • Ability to successfully perform in a high-energy, dynamic and team-oriented environment

  • Possess effective organization and time management skills with the ability to work under pressure and adhere to project deadlines

  • Possess excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization

  • Ability to demonstrate integrity within a professional environment

  • High degree of initiative, mature judgment, and discretion

  • Ability to handle confidential information in a professional manner

  • Possess a general understanding of the insurance industry, organizational relationships of the company and the functions of other departments such as Policy Operations and Marketing

  • Ability to manage conflict resolution

  • Ability to travel up to 10%


Desired Skills:


  • 7+ years of experience with a law enforcement agency and/or multi-line claims handling experience within the insurance industries

  • Possess prior experience in the investigation of insurance fraud

  • Successful completion of one or more professional designations: FCLS (Fraud Claims Law Specialist), CFE (Certified Fraud Examiner), CIFI (Certified Insurance Fraud Investigator)

  • Higher Educational Degree (Master's Degree)

Job Requirements

 
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SIU Field Investigator Senior Apply now