This job board retrieves part of its jobs from: Pennsylvania Jobs | Montreal QC Jobs | California Jobs

  Jobs in California  

Bringing the best, highest paying job offers near you

previous arrow
next arrow

SIU Field Investigator Senior

National General Insurance

This is a Full-time position in Sacramento, CA posted March 1, 2021.

Primary Purpose:

Identify and investigate questionable claims/risks and deliver facts and assistance to internal and external customers. Provides investigative assistance within the region and technical direction and support with complex SIU investigations

Essential Duties and Responsibilities:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

  • Assist SIU manager with duties to include special projects
  • Establish an investigative plan on a daily basis
  • Receive referral, communicate with referring sources, verify need for investigation and document all appropriate information
  • Initiate investigation by gathering facts and evidence with all interested parties
  • Complete appropriate reports
  • Run appropriate database checks
  • Take recorded statements when necessary
  • Netmap referrals as necessary
  • Hire appropriate experts with coordination of claim rep and supervisor and document investigative activity
  • Complete both inside and field investigative tasks
  • Work with vendors in setting expectations and resolving questions raised through the investigation
  • Track and document the quality of service provided by defense counsel and forensic experts and manage vendor costs
  • Evaluate facts and determine applicable laws
  • Determine state fraud reporting requirements; summarization of investigative findings
  • Identify answers to more complex issues with insurance law by reading and interpreting case law
  • Provide training to internal and external customers
  • Serve as mentor to SIU field investigators
  • Periodic audit review of files by supervisor or management
  • Conducts internal investigations regarding defalcation and employee misconduct issues as assigned

Minimum Skills and Competencies:

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Bachelor’s Degree or in-lieu of degree equivalent education, training and work-related experience
  • Possess a solid understanding of insurance law as it relates to claims and SIU files
  • Ability to interpret and apply investigative findings to determine action plan
  • Possess effective verbal and written communication skills
  • Ability to successfully perform in a high-energy, dynamic and team-oriented environment
  • Possess effective organization and time management skills with the ability to work under pressure and adhere to project deadlines
  • Possess excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization
  • Ability to demonstrate integrity within a professional environment
  • High degree of initiative, mature judgment, and discretion
  • Ability to handle confidential information in a professional manner
  • Possess a general understanding of the insurance industry, organizational relationships of the company and the functions of other departments such as Policy Operations and Marketing
  • Ability to manage conflict resolution
  • Ability to travel up to 10%

Desired Skills:

  • 7+ years of experience with a law enforcement agency and/or multi-line claims handling experience within the insurance industries
  • Possess prior experience in the investigation of insurance fraud
  • Successful completion of one or more professional designations: FCLS (Fraud Claims Law Specialist), CFE (Certified Fraud Examiner), CIFI (Certified Insurance Fraud Investigator)
  • Higher Educational Degree (Master’s Degree)
Please add your adsense or publicity code here (inc/structure/adsfooter.php)