Senior Claims SIU Inside Investigator

The Senior Claims SIU - Inside Investigator role functions as a inside anti-fraud investigator and carries out investigations that do not require field work or where field work can be tasked out to SIU field investigators or vendors.

What will you do:

• Investigate potential fraud by clients, third-party claimants, and suppliers (e.g., body shops, medical treatment providers) using internal resources and SIU vendors.
• Create the initial investigation strategy and update it as necessary though the life of the file.
• Examine submitted documents for discrepancies and verify their accuracy.
• Conduct thorough and effective audio-recorded interviews and obtain statements from clients, witnesses, and other relevant parties.
• Arrange and participate in examinations under oath as required.
• Identify patterns, quantify loss exposure, and develop mitigation action plans.
• Perform essential investigative tasks, such as acquiring official reports and consulting with experts or specialists for further insights.
• Compose final reports and provide recommendations to the claims department for the disposition of files.
• Review and prioritize incoming SIU referrals based on factors such as amount incurred, complexity, visibility, potential risk, and limitation dates.
• Assign files within the designated time frame to the appropriate SIU handler for further processing.
• Assist in designing and delivering regular, customized fraud awareness, detection, investigation, and avoidance training for various specialized lines of business, including Underwriting, Claims, and Business Development.
• Act as a subject matter expert on insurance fraud for all teams within the company, as well as for clients and brokers on an ad hoc basis.
• Ensure all investigations are conducted proactively and professionally, with utmost good faith, and that customer and broker inquiries are responded to promptly.
• Support inter-industry anti-fraud initiatives by attending industry training, CASIU events, Equite committee meetings, and other relevant events to maintain proficiency and stay informed about the latest trends in insurance fraud.
• Assist in the review, implementation, and ongoing use of artificial intelligence tools for fraud detection, including validation of outputs, tracking of savings driven by the tools, and reporting on the same.

What you will need to succeed

• 3+ years of insurance fraud investigation experience.
• 3+ years of claims handling experience. 
• Proven experience in conducting investigations related to fraud.
• Knowledge of anti-fraud practices and the ability to use various investigation techniques and resources.
• Strong analytical skills to identify patterns, quantify loss exposure, and develop mitigation plans.
• Strong interviewing and statement taking skills
• Excellent communication skills to prepare reports, conduct training, and interact with internal and external stakeholders.
• Ability to manage multiple tasks and prioritize incoming referrals.
• Familiarity with industry events, ongoing training, and use of artificial intelligence tools for fraud detection.
• Proficiency in maintaining databases and collaborating with internal partners to improve fraud detection processes.
• Commitment to maintaining professional relationships with industry partners and supporting inter-industry anti-fraud initiatives.
• Strong problem-solving skills and the ability to work independently and as part of a team.
• Prior P&C claims experience is preferred

Location: Hybrid: This is a hybrid role. Please note, regular in-person workdays at our Cambridge Office are expected minimum of once a week.

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