SIU Investigator - Major Case

Employer
Tower Hill Insurance Group
Location
Gainesville, Florida
Salary
Not Specified
Posted
Oct 02, 2019
Closes
Nov 30, 2019
Ref
6417930#GIJtoGJS.1
Industry
Insurance
Category
Insurance

UMMARY

Tower Hill Insurance Group’s Special Investigations Unit, is currently looking for a Major Case Investigator. This position will handle complex investigations which often involve organized and ring activity and some or all aspects of insurance operations, including: claims, underwriting, vendor relations, and agent services investigations. The Major Case Investigator will work closely with the SIU Manager, and will develop strong relationships with other departments of the company. The ideal candidate is an independent self-starter with strong investigative experience and property claims experience who will thrive in an innovative, collaborative environment. The position is located in Gainesville, Florida.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

  • Facilitates a team approach with the claims staff and management including the legal department in providing investigative insight, updates and recommendations on cases assigned.
  • Responsible for taking a proactive approach in investigations to identify parties involved and to make recommendations for implementation of investigative strategies to further deter, identify and resolve those matters identified in schemes to defraud.
  • Caseload is developed through intelligence gathering, data analysis and direct referral from both internal and external sources.
  • Analyze and interpret complex and voluminous evidence and convey highly technical information effectively to others.
  • Prepare and submit detailed investigative reports as necessary and make investigative recommendations in accordance with all applicable fraud statutes, case law and the policy contract.
  • Maintain communication with claims personnel, policyholders, and defense attorneys throughout investigative process.
  • Coordinate and attend Examinations under Oath.
  • Educate internal and external business partners (claims operations, internal adjusters, and underwriting staff) on ways to identify potential fraudulent activity that may require further investigation.
  • Mentor new SIU staff.
  • Coordinate with law enforcement / Department of Insurance Fraud as required by law.
  • Develop network of resources within the community (e.g., local fraud bureaus, district attorney offices, law enforcement agencies, insurance associations, professional associations, and community groups).
  • Keep current on industry activities and trends.
  • Assist SIU Management with file audits and serve as technical expert on developing best practices.
  • Provide training to our customers on fraud awareness, investigations and current statutory requirements.
  • Oversee investigations that are conducted by vendors to ensure that they are being done thoroughly and properly and that the customer is being kept appraised of the investigation in a timely manner

EDUCATION and/or EXPERIENCE

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

REQUIRED EDUCATION and/or EXPERIENCE

  • Bachelor’s degree OR five (5) years of relevant experience OR a combination of college education and relevant work experience equivalent to 5 years And Six (6) or more years combined professional claims experience in property/casualty, SIU / Investigative experience.

PREFERRED QUALIFICATIONS:

  • Bachelor’s degree.
  • Seven (7) or more years combined professional claims experience in property/casualty, SIU / Investigative experience.
  • Three (3) years of experience handling complex insurance claims investigations.
  • Knowledge in policy language and residential construction.
  • One or more of the following:
    • CIFI (Certified Insurance Fraud Investigator).
    • FCLA (Fraud Claims Law Associate).
    • FCLS, (Fraud Claims Law Specialist).
  • Previous investigative experience using a global approach to research organized activity, which includes more than one party.
  • Bilingual (English/Spanish).

SUCCESSFUL CANDIDATES ARE EXPECTED TO:

  • Contribute to team discussions
  • Become proficient with all tools and technologies
  • Be open with new ideas or proposals
  • Possess strong communication skills
  • Adaptable to change
  • Excellent customer focus

 TOWER HILL’S TOTAL COMPENSATION PACKAGE INCLUDES:

  • Competitive starting salary
  • Annual merit reviews and bonus potential
  • Medical, Dental, Life and Disability Insurance, and Health Savings Accounts
  • Matching 401(k) Plan
  • Paid PTO and holidays
  • Learning & Development Opportunities
  • Tuition Reimbursement
  • State of the Art work out facility (Corporate office)
  • Business casual dress, and more 

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