[Hiring] Insurance Fraud Investigator @United Auto Insurance

Role Description

As a Insurance Fraud Investigator I (SIU) for UAIC, you will be responsible for conducting field as well as desk investigations to detect fraud on high complexity claims involving staged auto accidents, fraud rings, and questionable medical treatment. You will provide investigative expertise to limit exposure and protect company assets. These investigations involve auto liability private passenger and commercial auto lines for non-standard policies. Investigations may include database searches, Examinations Under Oath, and scene canvasses. Focusing on thoroughness, quality, timeliness, and cost control. Our special investigator II will prepare and submit SIU investigative reports covering all phases of the investigation in each case for approval. You will maintain continued contact during investigations with supervision, internal legal professionals, external medical professionals, government/regulatory agencies, NICB, Law Enforcement, and outsourced vendors. The Investigator will also be responsible for effectively carrying out investigations of alleged Fraud, Waste, and Abuse by medical providers, body shops, and others.

Duties

• Conduct clinic inspections and examinations under oath.
• Conduct in-depth research and review of suspected fraudulent or abusive patterns to develop sufficient evidence to conclusively establish facts involving insureds, claimants, medical and auto body shop providers, or other entities.
• Collect, utilize, and interpret data from a variety of computer-generated reports and other sources; thereby identifying and documenting questionable patterns related to medical modalities, procedures, and other practices which merit further investigation.
• Maintain assigned investigation files, documents evidence, and prepares comprehensive investigation reports at the completion of each investigation.
• Assist in conducting comprehensive interviews: medical and other providers aforementioned, insureds/claimants in the presence of their attorneys where applicable, and witnesses to obtain statements and information admissible under accepted rules of evidence in civil and criminal court proceedings.
• Conduct special projects initiatives/investigations referred by the House Counsel.
• Establish and maintain liaison with NICB, Law Enforcement officers, and others to obtain assistance in conducting, facilitating, and enhancing investigations.
• Knowledgeable about all applicable insurance regulations, especially PIP regulations to ensure duties and assignments are carried out within the requirements of applicable law and office expectations.
• Mentor and teach less experienced investigators, promoting teamwork and collaboration among the department. Encourage sharing of insights, experiences, and best practices within the SIU team.

Qualifications

• Associate or bachelor’s degree in a related field preferred and/or 5 years of related work experience.
• Bilingual (English & Spanish).
• Knowledge of current procedural terminology.
• Strong critical thinking and analytical skills with the ability to interpret data and trends.
• In-depth knowledge of applicable fraud statutes, regulations, and industry best practices.
• High degree of integrity as demonstrated by appropriate treatment of confidential information, and adherence to policies, rules, and regulations.
• Effective communication and interpersonal skills, with the ability to build and maintain relationships with internal and external stakeholders.
• Excellent organizational and project management abilities, with a keen eye for detail.
• Expert knowledge of medical claims processing and investigations, a strong plus.
• Experience in CPT codes and medical terminology is highly preferred.
• Detail-oriented investigator with strong organizational and time management abilities.
• Analytical and interview skills: ability to make deductions; logical and sequential thinker.
• Computer literate; database and Internet proficient. Has knowledge of available resources (internal and external) to assist in investigations.
• Ability to work with others in a team environment.

Benefits

• 401(k) Retirement Savings Plan with employer match.
• Comprehensive Medical, Prescription Drug, Vision, and Dental Insurance.
• Paid Time Off, Holidays, and Leave programs.
• Flexible spending accounts.
• Basic Life Insurance and Voluntary Life/ADD.
• Short Term and Long-Term Disability.