Job Description
RESPONSIBILITIES - Investigation Investigates, aids and controls the efforts of the Acceptance SIU in its anti-fraud program.
- Conducts thorough analysis of a claim file, application, or insurance transaction that includes consideration of factors indicating insurance fraud.
- Identifies and interview potential witnesses who may provide information on the accuracy of the claim or application.
- Utilizes one or more industry-recognized databases identified by the SIU as appropriate for use in fraud investigations involving the specific line of insurance in question.
- Preserves documentation and/or other evidence obtained during an investigation.
- Writes concise and complete summary of the entire investigation, meeting the required criteria.
- Coordinates and conducts EUOs, examinations under oath, as warranted to aid in the outcome of a claim investigation.
- Investigates each credible referral of suspected insurance fraud that it receives from the integral anti-fraud personnel, including automated or system-generated referrals.
- Ensures effective implementation of fraud detection and/or deterrent protocols.
- Reports all suspected fraudulent insurance transactions to the appropriate parties within the required timeframes.
- Participates in the support and service resources to meet performance objectives and company expectations.
- Consistently utilizes SIU tools and benchmarks set by management.
- Continually evaluates and looks for ways to enhance possibilities towards fighting insurance fraud.
- Interpersonal Skills Works with all members of the Claims Management, Underwriting and Marketing Teams, Claim Support Staff, Independent Vendors, Defense Counsel, and all other entities as may be required.
- Testifies in civil and criminal actions related to investigations when required.
- Assists with the training of Acceptance anti-fraud personnel, including outside vendors as required, in fraud detection, prevention, and suspect claim handling measures.
- Represents the Company at various industry, state, and local organizations that focus on anti-fraud activities.
- Coordinates investigation of complex suspect claims and assignments as warranted, ensuring proper resolution.
- Collaborates with the SIU Managers on all matters of the SIU function.
- Establishes and maintains relationships with law enforcement, Department of Insurance officials, and insurance industry personnel and assists them when required.
- Other duties as assigned.
JOB REQUIREMENTS - Requires a bachelor’s degree or equivalent experience.
- Requires a minimum of 5 years of relevant experience.
- Prior law enforcement preferred.
- Experience handling Florida Personal Injury Protection (PIP) claims investigations is a plus (applies to FL positions only).
- Preferred designation as an insurance professional (including but not limited to AIC, CPCU, and SCLA.
- Proven management of SIU investigations, fraud investigations.
- Knowledge and understanding of SIU compliance.
- Proficient in Microsoft Suite (i.e., Word, Excel, PowerPoint, etc.)
- Proficient in interdepartmental knowledge, relations, and navigation.
- Excellent interpersonal and communication skills, including presentation skills.
- Strong organizational, time management, and/or prioritization abilities.
- Ability to work under tight deadlines with flexibility.
- Strong analytical and technical skills; superior business acumen.
- Excellent problem-solving, critical thinking, and decision-making skills.
- Commitment to First Acceptance’s company values.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to do manual tasks, which may include the use of hands to finger and handle controls.
Tasks may also require the ability to talk or hear. The employee will frequently sit, bend, and reach with hands and arms and is occasionally required to stand and walk. The employee may occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus. Other abilities include possessing the capacity to learn, concentrate, think, and read. Oftentimes the employee will be communicating and interacting with others while working.
Equal Opportunity Employer
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For further information, please review the Know Your Rights notice from the Department of Labor.
Job Tags
Local area, Remote work