Senior SIU Investigation Adjuster
Core
Investigate complex and highly complex insurance claims referred for potential fraud, including attorney-represented matters and extra-contractual liability.
Role type
Senior SIU Investigation Adjuster
Builds
Fraud detection outcomes and claim decisions for insurance carriers
Domain
Insurance / Fraud Investigation
Deliverable
physical/clinical work
Required skills
investigative research, evidence gathering, claims analysis, critical thinking, background research, witness interviews, scene investigations, medical record review, property damage review, analytical tools usage, documentation, customer conflict resolution
Preferred skills
3+ years investigative experience, insurance claims process knowledge, complex case evaluation, online data search, statement obtaining, independent remote work
Technologies
investigative intelligence tools, claims-management systems
Responsibilities
Conduct comprehensive investigations using background research, online searches, social media research, scene investigations, clinic inspections, and witness interviews. Obtain and analyze recorded statements from claimants, witnesses, and providers. Review and analyze medical records, bills, property damage documentation, and claim information. Follow up on leads to validate information accuracy and reliability. Use analytical tools to identify suspicious activity and strengthen evidence. Determine appropriate claim outcomes, including payment warrant and restitution pursuit. Document investigative findings, evaluations, and decisions clearly within claim systems. Enter and maintain SIU claim information across required systems. Manage and resolve complex customer communications, concerns, and conflicts. Provide investigative support for matters that may progress to litigation.
Seniority
Senior, hands-on IC