Encova Insurance · 19 hours ago
Senior SIU Investigator
United States
Full-time
Remote
Mid, Senior Level
$62K/yr - $124K/yr
3+ years expEncova Insurance is seeking a Senior SIU Investigator to conduct investigations into suspicious claims. The role involves reviewing claims, performing investigations, and providing training on fraud recognition to claims personnel.
Commercial InsuranceHealth InsuranceInsurance
Responsibilities
Review referred suspicious claims and identify the scope of investigation needed (full, limited or no investigation required) and provide feedback to the resolution specialist as needed on how to resolve the suspect issues in the claim
Investigate assigned suspicious claims
Determine and interview all parties who are material to the investigation
Independently perform investigative fieldwork to verify information and/or investigative leads
Utilize appropriate databases, informational resources and public records to verify information and/or investigative leads
Assign and oversee investigative vendors that are necessary for a thorough investigation including managing budgets and reports
Identify and communicate relevant coverage issues during the course of the investigation
Independently analyze data and facts to develop action plans and provide investigative conclusions
Perform other investigation and analysis as needed based on the requirements of the claim assignment
Prepare complete, detailed, and accurate narrative investigation reports, periodic status reports, and final opinions
Assist in the mentoring, development and providing of technical direction to other SIU investigators
Develop and mentor claims personnel regarding insurance fraud issues
Develop and coordinate training for SIU investigators in all phases of the investigation process
Work closely and communicate effectively with resolution specialists and claims leadership
Assist with fraud recognition training for resolution specialists and agents
Keep statistical data for transfer into SIU database and assist in developing data collection methods
Assist with and participate in examinations under oath
Review investigative results with resolution specialists and leadership before the claim is resolved
Appear in court as a company representative when needed
Represent SIU during claim reviews when needed
Assist in development of SIU field investigation standards and procedures
Generate and submit fraud reports to insurance departments
As directed by the SIU manager, may act as the department manager in the absence of the SIU manager
Complete various special projects and investigations as assigned
Network with industry personnel, law enforcement, legal counsel and others to develop information for investigative analysis and leads
Act as a subject matter resource providing fraud awareness, investigative consultation and mentorship to resolution specialists
Prepare and maintain an accurate travel itinerary and expense reports
Perform other duties as assigned
Qualification
Required
At least three years' experience in law enforcement, SIU investigation, or claims supervision; or at least four years as a resolution specialist
Strong interviewing and investigative proficiency
Strong interpersonal skills
Organizational and analytical skills
Strong case management, communication and presentation skills
Thorough understanding of claims processes and procedures
A college degree or equivalent experience in insurance
Possess the professional designation of CIFI (IASIU's Certified Insurance Fraud Investigator) or attain within 1 year of becoming an SIU Senior Investigator
Possess or attain the professional designation of FCLA (American Education Institute – Fraud Claims Law Associate) within 2 years of becoming an SIU Senior Investigator
Preferred
Multi-line insurance background
Benefits
Health, Dental & Vision Insurance
Company-provided life and income protection plans
Eligibility to participate in a company incentive bonus program
401(k) Retirement Plan - 100% company match up to 7% on annual salary
Paid Time Off, Paid Holidays, and Floating Holidays
Flexible Work Arrangements - Hybrid and remote depending on the role
Company
Encova Insurance
Encova Insurance offers insurance products including commercial, life and personal insurance.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2023-05-22Acquired
Leadership Team
Grady Campbell
Executive Vice President, Senior Advisor to President & CEO
Thomas J. “TJ” Obrokta, Jr.
President and CEO
Recent News
2025-09-17
2025-09-12
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