SIU Consultant – Triage
USAA
full-time
Posted on:
Location Type: Remote
Location: Arizona • Florida • United States
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Salary
💰 $77,120 - $147,390 per year
About the role
- Performs triage duties to review claims identified by our predictive fraud tool
- Investigates questionable, suspect claims activity in compliance with state insurance fraud-related laws and regulations and policies and procedures
- Applies knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third party claims
- Participates in the development of fraud prevention strategies
- Collects evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools
- Makes recommendations within defined authority guidelines
- Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results of the investigation and recommended outcomes
- Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention
- Assists with the delivery of fraud awareness training initiatives in a defined environment
- Handles CAT duty responsibilities as business requires
- Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
Requirements
- High School Diploma or General Equivalency Diploma (GED)
- 2+ years claims adjusting experience, or P&C SIU/Fraud Investigation experience OR 4+ years prior investigative law enforcement (to include military) or relevant fraud industry investigation experience
- Proven investigatory skills
- Experience obtaining statements from various parties to incidents, witnesses, and suspects
- Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud
- Demonstrated ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems
- Familiarity with using computers and various software packages to enter and extract data for analysis from relevant data sources and systems
- Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.
Benefits
- comprehensive medical, dental and vision plans
- 401(k)
- pension
- life insurance
- parental benefits
- adoption assistance
- paid time off program with paid holidays plus 16 paid volunteer hours
- various wellness programs
- career path planning and continuing education
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims adjustingfraud investigationinvestigatory skillsevidence collectiondata analysisreport writingfraud prevention strategiesrisk managementcomplianceforensic tools
Soft Skills
organizational skillsprioritizationproblem-solvingcommunicationrelationship buildingtraining deliveryattention to detailanalytical thinkinginterpersonal skillstime management
Certifications
High School DiplomaGeneral Equivalency Diploma (GED)