Major Case Field SIU Investigator Senior

4 weeks ago

San Antonio TX, United States USAA Full time

Why USAA?At USAA, we have an important mission: facilitating the financial security of millions of U.S. military members and their families. Not all of our employees served in our nation’s military, but we all share in the mission to give back to those who did. As a dedicated SIU field investigator, within defined guidelines and framework, you will help protect USAA and our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact to USAA. This may involve working with Legal Counsel, government agencies and outside consultants in compliance with state laws and regulations for an assigned operational specialty team.

This is a field-based role in Texas for the major case unit . Relocation assistance is not available for this position.

Leads the execution of fraud prevention strategies and investigative operations.
Leads high exposure, high profile and critical work assignments, and special investigations involving sophisticated niche fraud referrals, (examples: organized provider rings, staged accidents, large losses of significant exposure and broad scale PIP/Casualty Schemes) across multiple entities or functions.
Applies advanced knowledge of P&C insurance industry products, services, and processes in investigating claims. This includes P&C insurance policy contracts and coverages and claims handling process and procedures.
Applies advanced knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
Processes large quantities of unstructured detailed information with high levels of accuracy by collecting evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.
Makes appropriate and prompt decisions to identify potential complex fraud within defined guidelines.
Serves as subject matter authority for team members including providing expert mentorship and training for fraud investigations.
Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.
Ensures risks associated with business activities are effectively identified, measured, supervised, and controlled in accordance with risk and compliance policies and procedures.

4 years of P&C SIU/Fraud investigation experience; OR 6 years relevant fraud industry investigation experience.
~ Expert knowledge and understanding of fraud investigations as well as application of case law and state laws and regulations .
~ Ability to capture broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.
~ Experience using computers and various software packages to enter and extract data for analysis from relevant data sources and systems.
~ Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.
~ Experience in concurrent handling of specialty/complex/litigated claims/cases as well as mediation/arbitration/trial preparation and participation.  

3+ years of experience conducting multi-claim major case investigations in multiple jurisdictions
~ Comprehensive experience applying various causes of action for potential affirmative fraud litigation
~ Experience working in projects within SIU
~ Compensation: USAA has an efficient process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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