SIU Investigator

Company Overview:

CoventBridge Group is the leading worldwide full-service investigation solutions company providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. With offices in U.S. the company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.

About the Opportunity:

CoventBridge is seeking an experienced SIU Investigator to join our growing Operations department. The SIU Investigator role will conduct claim/ policy file evaluations to investigate and document suspected fraudulent activity related to insurance claims or policies, prepare SIU evaluation reports, updates, state mandated reporting forms and documented fraud referrals.  In addition, this position will obtain, document, and organize evidence that is suitable for presentation in a court of law to establish the presence of material misrepresentations and educate claims staff regarding insurance fraud, red flags, and the SIU process. 

Applicants must be familiar with the claims processes for multiple lines of insurance business including workers’ compensation, general liability, automotive and property claims and be able to provide in service training, including annual anti-fraud training, to integral anti-fraud client staff.

Educational Qualifications:

• Associates or bachelor’s degree (B.S. / B.A. in Criminal Justice, Business, or related field) from two or four-year college / university or equivalent SIU experience.

Responsibilities: 

• Conduct field investigations, including but not limited to, the following tasks: clinic/site inspections, recorded (in-person) statements, scene investigations including photographing and diagraming (as required), neighborhood canvasses and record searches/retrieval (in-person and computer assisted).
• Conduct in depth claim file reviews to determine if suspect activity on claim exists, make determination if claim needs to be reported to applicable state agency for compliance purposes, and make recommendations to client on further investigation that may be needed.
• Conduct verbal consultations with adjusters to discuss suspected fraudulent claim activity and assist in the identification of industry accepted red flags.
• Identify and articulate red flags, suspected fraudulent activity, material misrepresentations and other indicators of insurance fraud.
• Educate claims staff via in service training and verbal consultations to promote awareness of insurance fraud, industry accepted red flags, the SIU process, and investigative best practices.
• Make sound investigative recommendations to claims staff that will assist in the identification and investigation of insurance fraud and promote claims savings.
• Coordinate investigations of suspected fraudulent activity with CoventBridge investigators, case managers, 3^rd party vendors and prosecuting authorities.
• Obtain, document and report statistical information related to suspected fraudulent activity, red flags, state mandated reporting, arrests, convictions, sentencing, restitution, and claims savings.
• Obtain supporting documentation including claim documents, releases, and other records.
• Document all investigative efforts and case related communication in SmartPartner, CoventBridge’s case management system.
• Coordinate and liaison with federal, state and/or local law enforcement and Departments of Insurance when required and provide any requested documentation in a timely manner.
• Provide courtroom testimony.
• Due to driving, constant state of alertness in a safe manner is an essential function of this position.

Qualifications:

• Must have a broad understanding of multiple lines of insurance with a thorough understanding of both personnel and commercial lines of Property and Casualty preferred.
• Five (5) years of prior SIU experience or claim adjusting experience at either the carrier or TPA level or seven (7) years conducting complex insurance claims investigations or any combination of education and experience to demonstrate the competencies necessary to perform the essential job functions.
• Experience handling multi-claim/ ring related activity specific to Auto and GL claims.
• Must have in-depth knowledge of claim files handling investigations, settlement processes/ procedures, legal issues/ litigation processes as it relates to claims, Claims Best Practices and quality review procedures, and insurance industry operations including sales and underwriting functions.
• Must have a current Private Investigator’s License.

Requirements:

• Full coverage automobile insurance
• Required to have a current Driver's License
• Current Private Investigator's License (where applicable)
• Ability to travel to and from assignments daily
• Operate a motor vehicle in a safe manner

Benefits:

• Medical, Dental, Vision plans
• Life, LTD and STD paid by the employer
• 401(k) with company match up to 4%
• Paid Time Off and company paid holidays
• Tuition assistance after 1 year of service

The salary range for this role is $32.21 - $34.61 per hour. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future.  An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.

CoventBridge is an equal opportunity employer.  We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics.

CoventBridge is committed to the full inclusion of all qualified individuals.  As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com).