Insurance Claims Investigator
2 weeks ago
Delta Group is a leading national investigative firm with over 40 years of experience in providing quality investigative services to clients across the country. Our team of experts is dedicated to identifying and preventing fraudulent activity, ensuring the integrity of our clients' claims processes.
The Special Investigations Unit (SIU) of Delta Group is responsible for investigating and identifying questionable and suspicious claims for our partners. Our SIU investigators work closely with claims personnel, insurance carrier SIU staff, law enforcement, and government regulatory agencies to identify, prevent, and deter fraud.
JOB DUTIES:
- Conduct thorough investigations, including recorded statements and interviews of claimants, witnesses, and employers.
- Provide timely status updates to case managers and clients.
- Document claims files accurately and efficiently.
- Maintain confidentiality and professionalism at all times.
- Develop and implement effective investigative action plans.
- Ensure accuracy, quality, and timeliness of evidence gathered during investigations.
- Provide claim adjusters with timely investigation results and document findings.
- Determine whether additional evidence is required, including accident reports, witness statements, and expert opinions.
- Provide recommendations and decisions surrounding investigative efforts.
- Perform database queries to analyze and organize critical data.
- Evaluate state compliance referrals, as applicable, when questionable or suspicious activity is identified.
- Maintain active membership in professional organizations that provide SIU assistance and resources.
- Establish and maintain relationships with law enforcement, government regulatory agencies, and insurance industry personnel.
JOB REQUIREMENTS:
- Strong investigative skills and attention to detail.
- Ability to recognize patterns of inconsistencies that may be linked to fraudulent activity.
- Excellent verbal and written communication skills.
- Good organization and time management skills.
- Demonstrate knowledge of tools and techniques needed for conducting insurance claims investigations.
- Demonstrate proficiency with computer software, including Word, Excel, Outlook, and Teams.
- Ability to work independently and as part of a team.
EQUIPMENT NEEDED:
- Laptop computer
- Cell phone
- Audio recording device with download capability
- Digital camera
- Tape measure
EDUCATIONAL REQUIREMENTS:
- CFE or FCLS designations preferred
- 5-10 years' experience in claims and SIU investigations preferred
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