SIU Investigator Senior, Florida Major Case Unit (Field)
Posted on: May 26, 2023
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
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
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
- 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
- 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
- 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
- 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
- Must have or obtain a P&C adjusters license within 90
- Must be a results-oriented, skilled investigator with
experience taking complex statements from multiple parties to an
- Ability to gather broad range of evidence and draw conclusions
based on the objective details related to the applicability of
- 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
- Knowledge of city, state and local regulations, legal concepts,
understanding of contracts, case law, medical treatment, and
- Experience in concurrent handling of
specialty/sophisticated/litigated claims/cases as well as
mediation/arbitration/trial preparation and participation.What sets
- 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
- Proficient ability to analyze large amounts of data and produce
new case leads.
- Extensive experience with quality major case report writing and
- Extensive experience communicating case details & findings to
- Recent experience testifying in legal proceedings.
- Possesses a passion for training, mentoring and coaching.
- Demonstrated ability of working remotely with limited direct
- 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
Keywords: USAA, Orlando , SIU Investigator Senior, Florida Major Case Unit (Field), Accounting, Auditing , Casselberry, Florida
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