Job Description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior SIU Investigation Adjuster based in the United States. As a Senior SIU Investigation Adjuster, you’ll investigate complex and highly complex insurance claims referred for potential fraud. You’ll work across multidisciplinary claims, including attorney-represented matters, complex losses, and claims involving potential extra-contractual liability. Your work will combine investigative research, evidence gathering, claims analysis, and critical thinking to determine whether fraud can be substantiated. You’ll conduct activities ranging from background and online research to recorded statements, witness interviews, scene investigations, and medical or property-damage reviews. The role requires strong judgment and attention to detail when evaluating evidence, documenting findings, and determining appropriate claim outcomes. You’ll collaborate with claims teams and other stakeholders while ensuring investigations are thorough, accurate, and appropriately supported. This remote opportunity is suited to an experienced investigator who is comfortable handling sensitive information and complex cases independently. Accountabilities - Investigate complex and highly complex, multidisciplinary insurance claims referred to the Special Investigation Unit for potential fraud. - Conduct comprehensive investigations using background research, online searches, social media research, scene investigations, clinic inspections, witness interviews, and other investigative techniques. - Obtain and analyze recorded statements and evaluate information gathered from claimants, witnesses, providers, and other relevant parties. - Review and analyze medical records, medical bills, property damage documentation, claim information, and other evidence relevant to the investigation. - Follow up on all potential leads and validate that information obtained during an investigation is accurate, complete, and reliable.

- Use analytical tools, investigative intelligence, and available data to identify suspicious activity and strengthen evidence relating to potential fraud or damages. - Determine appropriate claim outcomes based on investigative findings, including whether payment is warranted and whether restitution should be pursued. - Review investigations resulting in potential fraud findings to assess whether the available evidence supports claim denial or other appropriate action. - Document investigative findings, evaluations, decisions, and supporting evidence clearly and comprehensively within claim systems. - Enter and maintain SIU claim information across required investigative and claims-management systems. - Update claim files with investigation outcomes and return matters for further handling and settlement when fraud is not established or evidence is insufficient. - Manage and resolve complex customer communications, concerns, conflicts, and issues that arise during the investigation process. - Conduct research and evaluation of complex online data sources to support investigations and claims decisions. - Provide investigative support for matters that may progress to litigation by maintaining accurate, well-documented evidence and investigative records. Requirements - 3+ years of investigative experience is preferred. - Demonstrated experience investigating insurance claims, fraud matters, or other complex investigative cases. - Strong understanding of insurance claims processes, special investigations, and fraud investigation principles. - Experience evaluating complex and potentially fraudulent claims using multiple sources of evidence. - Strong critical-thinking and analytical skills, with the ability to identify inconsistencies, assess evidence, and reach well-supported conclusions.

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