- Conduct timely investigations including recorded statements and interviews of claimants, witnesses, and employers.
- Provide timely status updates to case manager and client.
- Timely and clear documentation of the claim files.
- Maintain highest level of confidentiality and professionalism.
- Develop appropriate investigative action plan.
- Ensure accuracy, quality and timeliness of the evidence gathered during an investigation as well as compliance with all applicable laws, legal codes, and governing agencies.
- Provide Claim Adjuster with timely investigation results and document investigative findings.
- Determine whether additional evidence is required including but not limited to accident reports, accident scene reconstructions, witness statements, police reports, expert opinion, etc.
- Provide recommendations and decisions surrounding investigative efforts.
- Perform detailed database queries on SIU investigations to include analysis and organization of critical data to assist during the assigned investigation.
- Be able to evaluate State compliance referrals, as applicable, when questionable or suspicious activity is identified.
- Maintain active membership in professional organizations that provide SIU assistance and resources..
- Establish and maintain relationships with law enforcement, government regulatory agencies and insurance industry personnel assisting when needed or required.
- Strong investigative skills necessary.
- Must be detail oriented.
- Ability to recognize patterns of inconsistencies that may be linked to fraudulent activity.
- Must have ability to interact with clients, repair shops and appraisers, and employers.
- Ability to work independently.
- Excellent verbal and written communication skills.
- Good organization and time management skills.
- Demonstrate knowledge of tools and techniques needed for conducting insurance claims investigations.
- Demonstrate proficiencies with computer software, Word, Excel, Outlook and Teams.
- Must have the ability to utilize an objective perspective when performing tasks.
- Laptop Computer
- Cell Phone
- Audio Recording device with download capability
- Digital Camera
- Tape measure
- CFE or FCLS designations preferred
- 5-10 years' experience in claims and SIU investigations preferred
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SIU Investigator - Albany, United States - Delta Group
Description
Job Description
Job DescriptionSalary: $30 - $40 an hour DOEDelta Group is a privately held, woman-owned, national investigative firm established in 1983 and headquartered in Buford, Georgia. With over 40 years of experience, Delta Group was built on the foundations of three key factors: People, Innovation and Results. People have always been at the core of who we are at Delta Group, and we pride ourselves on a culture that fosters the development and growth of our team. When it comes to Innovation, Delta Group has integrated innovation as a key driver in the development of our quality investigative performance and results across everything that we do. Throughout 4 decades in business, Delta Group has always been a results-driven company. We have a longstanding history of commitment to our clients in building trust based on our results and relationships. We've seen many changes during our tenure, but one thing that has never changed is our commitment to providing quality results.
The Special Investigation Unit of Delta Group investigates and identifies questionable and suspicious claims for our partners, communicating with claims personnel, insurance carrier SIU staff, law enforcement, and government regulatory agencies to identify, prevent and deter fraud. The candidate should have extensive experience with claims for all lines of insurance, with a heavy emphasis on Workers' Compensation claims.
JOB DUTIES:
JOB REQUIREMENTS:
EQUIPMENT NEEDED:
EDUCATIONAL REQUIREMENTS:
remote workCompany DescriptionDelta Group is a family-owned investigative firm and has been in business for over 30 years. We have serviced many of the largest insurance companies, third party administrators, self-insureds and PEOs in the country. Our services are unrivaled, and we are highly dedicated to the fight against insurance fraud.
