SIU Investigator Senior, Florida Major Case Unit (Field)

Company: USAA
Location: Casselberry
Posted on: May 26, 2023

Job Description:

Why USAA?Lets do something that really matters.

At USAA, we have an important mission: facilitating the financial security of millions of U.S. military members and their families. Not all of our employees served in our nations military, but we all share in the mission to give back to those who did. Were working as one to build a great experience and make a real impact for our members.

We believe in our core values of honesty, integrity, loyalty and service. Theyre what guides everything we do from how we treat our members to how we treat each other. Come be a part of what makes us so special!

Within defined guidelines and framework, protects USAA and our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact to USAA which may involve Legal Counsel, government agencies and outside consultants in compliance with state laws and regulations for an assigned operational specialty team.The OpportunityWe are seeking a dedicated Senior SIU (Special Investigations Unit) Investigator for the Florida state region, who will be tasked with conducting major case investigations involving 1st and 3rd party medical claims.This position is a remote/field work type and can be based in any major metro area of Florida. The position will involve travel throughout the state.What you'll do:

• Leads the execution of fraud prevention strategies and investigative operations.
• Leads high exposure, high profile and sensitive work assignments, and special investigations involving complex specialized fraud referrals, (examples: organized provider rings, staged accidents, large losses of significant exposure and broad scale PIP/Casualty Schemes) across multiple entities or functions.
• Applies advanced knowledge of P&C insurance industry products, services, and processes in investigating claims. This includes P&C insurance policy contracts and coverages and claims handling process and procedures.
• Applies advanced knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
• Processes large quantities of unstructured detailed information with high levels of accuracy by collecting 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 appropriate and prompt decisions to identify potential complex fraud within defined guidelines.
• Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results and outcome of the investigation.
• Serves as subject matter expert for team members including providing expert guidance and training for fraud investigations.
• Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.
• Develops proactive actions and conveys compelling arguments to influence disposition of arbitrated and litigated cases effectively and efficiently.
• Handles CAT duty responsibilities as business requires.
• Identifies and manages existing and emerging risks that stem from business activities and the job role.
• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled.
• Follows written risk and compliance policies, standards, and procedures for business activities.What you have:
  • High School Diploma or General Equivalency Diploma.
  • 4 years of P&C SIU/Fraud investigation experience; OR 6 years relevant fraud industry investigation experience.
  • Expert knowledge and understanding of fraud investigations as well as application of case law and state laws and regulations.
  • Must have or obtain a P&C adjusters license within 90 days.
  • Must be a results-oriented, skilled investigator with experience taking complex statements from multiple parties to an event.
  • Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.
  • Proven ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems.
  • Experience 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.
  • Experience in concurrent handling of specialty/sophisticated/litigated claims/cases as well as mediation/arbitration/trial preparation and participation.What sets you apart:
    • 5+ years claims handling experience handling 1st and 3rd party medical claims within Property & Casualty on Florida claims.
    • 5+ years SIU experience handling major case investigations involving 1st and 3rd party medical claims in a Major Case Unit, preferably on Florida investigations.
    • Solid understanding of analyzing CPT codes and medical billing/reports.
    • Proficient ability to analyze large amounts of data and produce new case leads.
    • Extensive experience with quality major case report writing and case management.
    • Extensive experience communicating case details & findings to various audiences.
    • Recent experience testifying in legal proceedings.
    • Possesses a passion for training, mentoring and coaching.
    • Demonstrated ability of working remotely with limited direct supervision.
    • Experience conducting field work independently. Field work, including overnight travel will be required.The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.What we offer:Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. The salary range for this position is: $78,670 - $141,570.Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.For more details on our outstanding benefits, please visit our benefits page on USAAjobs.com.Relocation assistance is not available for this position.USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Keywords: USAA, Orlando , SIU Investigator Senior, Florida Major Case Unit (Field), Accounting, Auditing , Casselberry, Florida