[Hiring] Special Investigations Unit Investigator @Davies

Role Description

We are on the lookout for an experienced Special Investigations Unit (SIU) Investigator to join our team! You will be responsible for conducting comprehensive investigations involving suspected fraud, misrepresentation, claim irregularities, and other potentially questionable activity.

• Conduct comprehensive SIU investigations involving suspected fraud, misrepresentation, claim irregularities, and other potentially questionable activity.
• Investigate insurance claims by researching claimant activity, employment history, business interests, prior claims, relationships, and other relevant areas of inquiry.
• Conduct detailed background investigations using public records, proprietary databases, court records, business records, social media, and other approved investigative resources.
• Handle investigations across multiple lines of business, including Workers’ Compensation, General Liability, Auto, Property, and other insurance-related matters.
• Review claim files, SIU referrals, supporting documentation, and available evidence to develop effective investigative strategies and appropriate next steps.
• Identify investigative leads, inconsistencies, fraud indicators, and opportunities for additional investigative activity.
• Conduct interviews and obtain recorded or written statements, as appropriate.
• Coordinate investigative activities with claims professionals, SIU leadership, clients, attorneys, and other stakeholders as needed.
• Prepare clear, accurate, timely, and professional investigative reports documenting findings, evidence, activities performed, and recommended next steps.
• Maintain accurate case documentation and ensure investigations are completed in accordance with applicable regulations, client requirements, and internal procedures.
• Manage assigned caseload effectively while meeting established quality standards, deadlines, and service expectations.
• Maintain confidentiality and appropriately handle sensitive claim and investigative information.

Qualifications

• Workers’ Compensation investigative experience is required.
• Prior experience conducting SIU, insurance fraud, claims, law enforcement, corporate, or related investigations.
• Demonstrated experience conducting background investigations and researching public records and investigative databases.
• Strong interviewing, investigative research, analytical, and report-writing skills.
• Ability to analyze claim documentation and recognize inconsistencies, suspicious activity, and potential fraud indicators.
• Strong organizational and time-management skills with the ability to manage multiple investigations simultaneously.
• Excellent written and verbal communication skills.
• Ability to work independently in a remote environment while collaborating effectively with internal teams and clients.
• Proficiency with Microsoft Office and familiarity with claims management, investigative research, or case management systems.

Requirements

• Investigative experience across multiple insurance lines, particularly Workers’ Compensation, General Liability, Auto, and Property.
• Previous experience working within an insurance carrier, third-party administrator (TPA), SIU, investigative firm, or law enforcement environment.
• Experience conducting field investigations, interviews, statements, background investigations, and social media or open-source research.
• Experience with Premium Fraud investigations.
• Familiarity with insurance fraud regulations and SIU compliance requirements.
• Candidates located in Southern California or Central Florida are strongly preferred.

Benefits

• Medical, dental, and vision plans to support your health and that of your family.
• A 401(k) plan with employer matching.
• Time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non-exempt employees.
• Paid holidays.
• Life insurance and short-term and long-term disability coverage.
• Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee’s primary work location.
• Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements.