Claims SIU Specialist

Our Special Investigations Unit (SIU) Team is hiring! We’re looking for a field investigator who’s a subject matter expert on anti-fraud for Gore Mutual.

As a Field SIU Specialist, you will be given a company car to ensure that you’re ‘boots on the ground’ to conduct on-site investigations of claims, collecting statements, and gathering various forms of evidence.

What you will do:

• Investigate to determine if there is evidence of fraud by clients, third party claimants, suppliers (body shops, medical treatment providers, etc).
• Conduct on-site investigations and obtain in person statements.
• Review submitted documents for inconsistencies/other signs of fraud.
• Compose final reports and recommendations to our Claims department for disposition of file.
• Educate front line staff, clients, and brokers on fraud as a subject matter expert.
• Assist in the design and delivery of regular, customized fraud detection, investigation, and avoidance training for the various specialized lines of claims handlers & underwriters.
• Attend Examinations under oath where required and oversee claims in litigation.
• Provide mentoring and coaching to junior team members.
• Regularly attend industry training, CASIU events, and others to maintain proficiency and ensure Gore is aware of the latest trends in Insurance Fraud. Prepare and deliver education sessions to highlight trends and promote fraud awareness among different stakeholders such as underwriting & claims teams and external broker partners.

What you will need:

• 10+ years of investigative insurance experience.
• 5+ years of training/mentorship experience.
• Previous experience with Claims (Guidewire considered an asset).
• Property, Auto, Accident Benefit & Casualty claims investigation experience.
• CIP, CFEI, or CFE designations completed or in progress.
• Post secondary school completion is a requirement.
• Familiarity with anti-fraud technology in detection of potential fraud

Location: This is primarily a remote and field role, and requires presence in our Cambridge office once every 2 weeks for a team meeting. 

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