Senior Workers' Compensation SIU Investigator

4 weeks ago

Los Angeles, United States ICW Group Full time

Are you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hire innovative people who consistently adapt, grow and deliver. We believe in hard work, a fun work environment, and embracing creativity that only comes about when talented people collaborate to develop solutions. Our mission to create the best insurance experience possible.

Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for seven consecutive years as a Top 50 performing P&C company offering the stability of a large, profitable and growing company combined with a small-company entrepreneurial spirit. Our purpose-driven ethos provides team members with opportunities to contribute, develop, and belong.

The Senior SIU Investigator will detect, prevent, and investigate suspected fraudulent claims with heavy emphasis on Workers' Compensation claims. This position exists to protect company assets through examining potential fraudulent cases.

This is a remote position with travel within the following territories: Orange County, Los Angeles, and Riverside County.

WHAT YOU WILL DO

Detects and investigates suspected fraudulent claims.

  • Analyzes, organizes, and investigates multi-line types of fraud investigation.
  • Evaluates all referrals for fraud and ensures essential data is located and documented.
  • Ensures investigative results are acted upon and measures ROI of same.
  • Conducts investigations with a focus on thoroughness, quality, with attention to detail, timeliness, and cost control.
  • Maintains a systematic and effective method to detect and investigate suspected fraudulent claims and provides for their appropriate disposition.
  • Locates, extracts, analyzes, and organizes critical data from multiple systems to prevent and detect fraud.
  • Understands applicable laws, legal codes, court procedures, precedents, government regulations, executive orders, and agency rules for effective investigations.
  • Prepares and submits timely investigative reports covering all phases of the investigation.
  • Utilizes prescribed case management system (Polonious) to document the detection, investigation and tracking of suspected fraudulent claims, actively moving them towards their appropriate disposition.
  • Identifies persons or organizations involved in suspicious claims activities.

Manages relationships and keep consistent communication with multiple departments and outside agencies.

  • Prepares and presents completed investigations to appropriate senior staff and/or criminal justice personnel in a highly professional and timely manner.
  • Maintains contact during the course of investigations with Examiners, Risk Management, Auditors, Hearing Reps, Marketing, Underwriting, Claimants, Policyholders, Agents, Brokers, SIU, Legal and Medical professionals, Government/Regulatory Agencies, Law Enforcement and Vendors.
  • Facilitates effective communications with regulatory and enforcement agencies.
  • Coordinates vendors to ensure appropriate outcomes and efficient pricing.

Prevents future insurance fraud through training others and keeping abreast on industry research.

  • Provides anti-fraud outreach training programs for insured accounts (management and employees) and ICW agents when asked for or when problems are identified.
  • Recognizes, reports, and promotes sound anti-fraud fighting procedures, techniques and impacts.
  • Educates and trains all integral anti-fraud personnel including Claim Examiners, Underwriters, and Premium Auditors to identify possible insurance fraud.

WHAT YOU BRING TO THE ROLE

  • Associates degree required in Criminal Justice, Business, Accounting, Computer Science, or related field. Bachelor's degree preferred. Additional relevant experience may be considered in lieu of degree.
  • Minimum 5 years of SIU, legal, claims, and/or law enforcement experience required, 8 years without a degree.

CERTIFICATES, LICENSES, REGISTRATIONS

  • Private Investigator's License or fraud related certificates (CFE, CIFI) are recommended, but not necessary given proper background.

KNOWLEDGE AND SKILLS

  • Solid working knowledge of SIU, legal, claims and/or law enforcement.
  • Fundamental knowledge of claims management processes and claims handling; knowledge of Unfair Claims Practices Act, Legislative, and Insurance Department regulatory requirements; civil and criminal investigation procedures and the legal system.
  • Demonstrated experience with managing relationships to complete thorough investigations.

COMPENSATION

The salary range listed for this position, $74,932.01 to $126,367.76, is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors such as skills, experience and/or education. In addition, we believe in the importance of pay equity and consider internal equity of our current team members as part of any final offer. We typically do not hire at the maximum of the range in order to allow for future and continued salary growth. We also offer a substantial benefits package outlined below.

WHY JOIN ICW GROUP?

  • Challenging work and the ability to make a difference
  • You will have a voice and feel a sense of belonging
  • We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
  • Bonus potential for all positions
  • Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year)
  • 10 paid holidays throughout the calendar year
  • Want to continue learning? We'll support you 100%

ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.

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