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USAA · 2 days ago

SIU Consultant P&C (Mid-Level) - Desk

Las Vegas, NV

Full-time

Hybrid

Entry, Mid Level

$77K/yr - $147K/yr

2+ years exp

USAA is dedicated to empowering its members to achieve financial security through exceptional service and products. They are seeking a mid-level SIU Consultant to investigate potential fraudulent claims and develop fraud prevention strategies while ensuring compliance with insurance regulations.

BankingFinancial ServicesInsuranceVenture Capital

No H1B

Responsibilities

Applies knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third part claims

Participates in the development of fraud prevention strategies

Applies knowledge of P&C insurance industry products, services, and processes in investigating claims to include P&C insurance policy contracts, coverages and internal claims handling process and procedures

Applies knowledge of state laws and regulations pertaining to insurance fraud in investigating claims

Collects evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools

Makes recommendations within defined authority guidelines

Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results of the investigation and recommended outcome

Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention

May serve as a resource team member on specific matters through demonstrated skill or training

Assists with the delivery of fraud awareness training initiatives in a defined environment

Handles CAT duty responsibilities as business requires

Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures

Qualification

Fraud investigationP&C insurance knowledgeAnalytical skillsSQLPythonDigital fraud detection toolsInvestigatory skillsCommunication skillsOrganizational skills

Required

High School Diploma or General Equivalency Diploma (GED)

2+ years claims adjusting experience, or P&C SIU/Fraud Investigation experience OR 4+ years prior investigative law enforcement (to include military) or relevant fraud industry investigation experience

Proven investigatory skills

Experience obtaining statements from various parties to incidents, witnesses, and suspects

Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud

Demonstrated ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems

Familiarity with using computers and various software packages to enter and extract data for analysis from relevant data sources and systems

Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology

Preferred

Strong analytical skills to include ability to write SQL, Python and leverage analytical databases such as snowflake, Alteryx, etc

2+ years of SIU or related insurance claim/policy investigative experience, basic understanding of SIU red flags

Experience using digital fraud detection tools for analysis, to include digital fraud detection performance, outliers and development of new fraud detection rules

Ability to work individually in a fast paced environment and process large quantity of alerts/referrals with a high level of quality and accuracy in decision making

Bachelor's degree or equivalent experience considered

Excellent written and verbal communication skills, including presentation experience