SIU Investigator I (Medical Field Inv)

Purpose of Job

This Position may be filled as a SIU Major Case Unit Investigator or a SIU Field Medical Investigator

Ideal Candidate will reside in either Arizona, California or Nevada

Provides specialized investigative and advisory services to Claims, Underwriting and Policy Service on moderately complex to complex situations involving questionable, suspect or fraudulent claims activity. Works with law enforcement, fire and other related agencies to investigate potential fraud. Works under minimal supervision to perform work assignments and problem resolution. Participates in the development of fraud prevention strategies and independently completes investigations.

Job Requirements

  • Demonstrates an understanding of common fraud schemes and develops investigative strategies.
  • Reviews initial referrals, evaluates claim and underwriting information to identify appropriate assignment level and investigative strategies.
  • Independently develops and presents verbal & written investigative and management reports.
  • Acquires and applies proficient knowledge of state laws & regulations pertaining to insurance fraud.
  • Acquires and applies proficient knowledge of P&C insurance industry products, services and processes to include P&C insurance policy contracts and coverages and USAA claim handling process and procedures.
  • Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection and prevention.

Minimum Requirements

  • High School Diploma or GED
  • 2 more years prior casualty claims adjusting, claim investigating experience, law enforcement, or P&C special investigative experience

*Qualifications may warrant placement in a different job level.*

When you apply for this position, you will be required to answer some initial questions. This will take approximately 5 minutes. Once you begin the questions you will not be able to finish them at a later time and you will not be able to change your responses.

Preferred

  • SIU Major Case Unit investigation experience
  • SIU 3rd Party Medical Field Investigation experience
  • Solid knowledge and experience working on investigations involving staged accidents, providers and medical billing
  • Strong verbal/written communication skills summarizing complex injury investigations
  • Proficiency in establishing, documenting, and pursuing appropriate investigative strategies
  • Ability to develop and present injury fraud related training programs
  • Ability to work with minimal supervision developing complex investigations and manage work proficiently
  • Possess active adjuster's license or ability to obtain same
  • Working knowledge in state laws and regulations pertaining to insurance fraud
  • Professional designations related to SIU (e.g. CIFI, CFE, FCLS, etc)

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

At USAA our employees enjoy one of the best benefits packages in the business, including a flexible business casual or casual dress environment, comprehensive medical, dental and vision plans, along with wellness and wealth building programs. Additionally, our career path planning and continuing education will assist you with your professional goals.

USAA also offers a variety of on-site services and conveniences to help you manage your work and personal life, including seven cafeterias, two company stores and three fitness centers.

Relocation assistance is not available for this position.

For Internal Candidates:

Must complete 12 months in current position (from date of hire or date of placement), or must have manager’s approval prior to posting.

Last day for internal candidates to apply to the opening is 10/04/18 by 11:59 pm CST time.