Overview:
SIU Senior Investigator - West Coast Operations
Company Overview:
CoventBridge Group is the leading worldwide full-service investigation solutions company providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. With offices in the UK and U.S. the company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.
About the Opportunity:
CoventBridge is seeking an experienced SIU Senior Investigator to join our growing Operations department.
The SIU Senior Investigator is responsible for conducting complex, thorough and timely investigations involving potential insurance fraud where questionable or suspicious activity has been identified. This role involves the ability to effectively protect, prevent, and detect fraud by actively being involved in anti-fraud efforts. In addition, this position will obtain, document, and organize evidence that is suitable for presentation in a court of law to establish the presence of material misrepresentations and educate claims staff regarding insurance fraud, red flags, and the SIU process.
This is a remote position; however, the employee must physically be in either the Pacific or Mountain Time Zone to support CoventBridge’s clients with West Coast claim’s operations.
Responsibilities/ Requirements:
Educational Qualifications:
- Bachelor’s Degree
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Completion of one or more of the following designations: CIFI, FLCS, FCLA, and/or CFE
Responsibilities:
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Identify, analyze, and conduct thorough investigations of suspicious claims in a timely manner.
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Ensure accurate, detailed, and timely interviews are completed with applicable parties.
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Evaluate, analyze, verify, and obtain material evidence relevant to the investigation.
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Locate, extract, and review data from multiple sources and systems to assist during the investigation to ensure accuracy in findings.
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Evaluate and coordinate vendor involvement when deemed necessary by establishing a cost-effective budget when utilizing SIU vendors and experts.
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Ensure all investigative findings are properly and thoroughly documented in a timely manner.
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Evaluate, determine, and complete referrals to State Insurance Departments, Fraud Bureaus, and NICB when suspicious and fraudulent activity has been identified.
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Facilitate and coordinate investigations with external SIU contacts, NICB, Department of Insurance Fraud, and various law enforcement agencies.
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Facilitate and maintain effective professional communication by providing best in class service to both internal and external customers.
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Develop and present anti-fraud training to claims personnel.
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Participate in decision making discussions with Company personnel on cases worked and resolution on investigative results.
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Provides effective technical advice on SIU related investigative issues in addition to communication of industry data, trends, government, and legal updates.
- Produce investigative reports to SIU leadership through data mining, pattern analysis and claim trends.
Qualifications:
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Seven (7) years of investigative experience with at least five (5) years of prior carrier SIU experience.
- Must understand multiple lines of insurance with thorough knowledge of personal, commercial and casualty lines of business.
- Exhibit knowledge of basic insurance principles pertaining to claims processes and procedures.
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Knowledge of good faith claims practices
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Demonstrate knowledge of investigative methods regarding laws, rules and regulations involving insurance fraud.
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Knowledge of California Department of Insurance (CDI) statutes, policies, requirements, and submission of CDI eFD-1 notices.
- Knowledge of privacy regulations and compliance requirements
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Dedicated to meeting the expectations of internal and external customers.
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Ability to work both independently and in a team environment.
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Excellent verbal and written communication skills.
Requirements:
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Must have a current or the ability to obtain a Private Investigator’s License.
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Ability to travel as business needs dictate.
- Full coverage automobile insurance
- Required to have a current Driver's License
- Operate a motor vehicle in a safe manner
Benefits:
Benefits:
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Medical, Dental, Vision plans
- Life, LTD and STD paid by the employer
- 401(k) with company match up to 4%
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Paid Time Off and company paid holidays
- Tuition assistance after 1 year of service
The hourly range for this role is $36.05 - $40.06 ($75k - $85k annualized). This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics.
CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com).
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