SIU Investigator Job at Delta Group, Fresno, CA

RFFVd1cwWlJxNk5NYlV0aDB6YzRid2lVWWc9PQ==
  • Delta Group
  • Fresno, CA

Job Description

The Special Investigation Unit of Delta Group investigates and identifies questionable and suspicious claims for our partners, communicating with claims personnel, insurance carrier SIU staff, law enforcement, and government regulatory agencies to identify, prevent and deter fraud. The candidate should have extensive experience with claims for all lines of insurance, with a heavy emphasis on Workers’ Compensation claims.

JOB DUTIES:

  • Conduct timely investigations including recorded statements and interviews of claimants, witnesses, and employers.
  • Provide timely status updates to case manager and client.
  • Timely and clear documentation of the claim files.
  • Maintain highest level of confidentiality and professionalism.
  • Develop appropriate investigative action plan.
  • Ensure accuracy, quality and timeliness of the evidence gathered during an investigation as well as compliance with all applicable laws, legal codes, and governing agencies.
  • Provide Claim Adjuster with timely investigation results and document investigative findings.
  • Determine whether additional evidence is required including but not limited to accident reports, accident scene reconstructions, witness statements, police reports, expert opinion, etc.
  • Provide recommendations and decisions surrounding investigative efforts.
  • Perform detailed database queries on SIU investigations to include analysis and organization of critical data to assist during the assigned investigation.
  • Be able to evaluate State compliance referrals, as applicable, when questionable or suspicious activity is identified.
  • Maintain active membership in professional organizations that provide SIU assistance and resources.
  • Establish and maintain relationships with law enforcement, government regulatory agencies and insurance industry personnel assisting when needed or required.

JOB REQUIREMENTS:

  • Strong investigative skills necessary
  • Must be detail oriented
  • Ability to recognize patterns of inconsistencies that may be linked to fraudulent activity
  • Must have ability to interact with clients, repair shops and appraisers, and employers.
  • Ability to work independently
  • Excellent verbal and written communication skills
  • Good organization and time management skills
  • Demonstrate knowledge of tools and techniques needed for conducting insurance claims investigations
  • Demonstrate proficiencies with computer software, Word, Excel, Outlook and Teams

EQUIPMENT NEEDED:

  • Laptop Computer
  • Cell Phone
  • Audio Recording device with download capability
  • Digital Camera
  • Tape measure

EDUCATIONAL REQUIREMENTS:

  • CFE or FCLS designations preferred
  • 5-10 years’ experience in claims and SIU investigations preferred

The final job level and annual salary will be determined based on the education, qualification, knowledge, skills, ability, and experience of the final candidate(s), and calibrated against relevant market data and internal team equity.

Delta Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex (including pregnancy, sexual orientation, gender identity / expression), national origin or ancestry, genetic information (including family medical history), physical or mental disability, protected veteran status, or any other characteristic protected under federal, state or local law, where applicable, and those with criminal histories will be considered in a manner consistent with applicable state and local laws.

Job Tags

Local area,

Similar Jobs

Globe Life AIL - Luis Luna

Appointment Setter - Work From Home Job at Globe Life AIL - Luis Luna

We are looking for anAppointment Setterto join our team and support our sales team by contacting...  ...monthly meeting goals. Duties : ~Schedule appointments through phone ~...  ...Dispatch incoming customer phone calls ~Work and learn from management teams to stay... 

Get It - Finance

Tax Accountant / Bookkeeper Job at Get It - Finance

Are you an experienced Tax Accountant & Bookkeeper looking for an opportunity to work in a dynamic and collaborative environment? We are seeking a detail-oriented professional with 2-3 years of experience to assist with federal and state tax compliance, tax preparation... 

OnWay Transport, LLC

Medical Supply Delivery Driver Job at OnWay Transport, LLC

 ...partnering with Independent Contractors to deliver medical supplies between New Milford and Danbury. These deliveries will take place 3x per day Monday-Friday and will...  ...Supply delivery. Using Courier App. Valid Drivers License. Must be 21 years of age. Current... 

Johns Hopkins Medicine

Pharmacist Job at Johns Hopkins Medicine

 ..., we have access to the most innovative treatments and latest research, and we emphasize education and training among our team members...  ...Hopkins Medicine to ensure continuity of your care. This pharmacist position supports all Johns Hopkins Outpatient Pharmacies, including... 

INFICON

Industrial Engineering Co-Op/Intern Job at INFICON

 ...technologies, and Smart Manufacturing/Industry 4.0 software solutions that enhance productivity...  ...-op/intern will assist the Industrial Engineering/Lean Team with: continuous improvement,...  ...Knowledge of AutoCAD Previous Co-Op/Internship Experience or Previous Work Experience...