- Conducts investigations of suspected fraudulent activity. Coordinates fraud detection and investigative findings with claims professional and other Company personnel to optimize results in addressing fraudulent activity.
- Provides advice and technical guidance to claims professional on fraud-related issues, claim negotiation and settlement.
- Communicates regularly with vendors regarding SIU related services and expense management.
- Facilitates fraud-related training for Company personnel.
- Participates with and provides supporting evidence to law enforcement authorities in the prosecution of fraudulent activities.
- Maintains and demonstrates advanced knowledge and understanding of medical terminology, coding and billing, fraud investigation techniques, legal briefs, surveillance and investigative reports.
- Communicates regularly with claims management regarding status of fraud-related activities.
- Assists in completing state mandated regulatory reporting.
- Four-year degree or equivalent work experience.
- Demonstrated progress toward or completion of industry-accepted designation.
- Previous SIU experience, preferred.
- Minimum of 3-years work experience in business environment or related field demonstrating strong investigative, analytical and communication skills.
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Special Investigations Unit Investigator - North Richland Hills, United States - Federated Mutual Insurance Co
Description
Who is Federated Insurance?:
At Federated Insurance, we do life-changing work, focused on our clients success. For our employees, we provide tremendous opportunities for growth. Over 95% of them believe our company has an outstanding future. We make lives better, and were looking for employees who want to make a difference in others lives, all while enhancing their own.
Federateds culture is grounded in our Four Cornerstones: Equity, Integrity, Teamwork, and Respect. We strive to create a work environment that embodies our values and commitment to diversity and inclusion. We value and respect individual differences, and we leverage those differences to achieve better results and outcomes for our clients, employees, and communities. Our top priority in recruitment and development of our next generation is to ensure we align ourselves with truly exceptional people who share these values.
What Will You Do?:As a Special Investigations Unit (SIU) Investigator, you are responsible for conducting in-depth investigation of questionable and potentially fraudulent claims for all lines of insurance sold by Federated Insurance Companies.
Responsibilities
Minimum Qualifications
We offer a wide variety of ways to support you as a whole, both professionally and personally. Our commitment to your growth includes opportunities for internal mobility and career development paths, inspiring excellence in performance and ensuring your professional journey thrives. Additionally, we offer exceptional benefits to nurture your personal life. We understand the importance of health and financial security, offering encompassing competitive compensation, enticing bonus programs, cost-effective health insurance, and robust pension and 401(k) offerings. To encourage community engagement, we provide paid volunteer time and offer opportunities for gift matching. Discover more about Federated and our comprehensive benefits package: Federated Benefits You.
Employment Practices:All candidates must be legally authorized to work in the United States for any employer. Federated will not sponsor candidates for employment visa status, such as an H1-B visa. Federated does not interview or hire students or recent graduates with J-1 or F-1 visas or similar temporary work authorization.
If California Resident, please review Federated's enhanced Privacy Policy.
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