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USAA · 2 days ago

SIU Investigator (Desk) - P&C (mid-level) - New York City metro

New York Metro, NY Home

Full-time

Hybrid

Entry, Mid Level

$77K/yr - $147K/yr

2+ years exp

USAA is a financial services organization that aims to empower its members to achieve financial security. The SIU Investigator will be responsible for investigating potential fraudulent claims and ensuring compliance with state insurance fraud-related laws and 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

P&C insurance knowledgeFraud investigation skillsInvestigative reportingClaims adjusting experienceEvidence gatheringRegulationsMilitary experienceSoftware proficiencyFraud awareness trainingDesignations CFEDesignations CIFIDesignations etc.Organizational skillsCommunication skillsRelationship buildingProblem-solving 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

SIU experience conducting low to complex PNC fraud investigations OR a combination of Claims and Law Enforcement Investigations OR Military Investigative experience

Designations such as CFE, CIFI, SCLA, ACLS, FCLS, LPCS, AIC, CPCU, CCLS, or other

US military experience through military service or a military spouse/domestic partner