SIU Sr. Investigator

Company Details

"Our Company provides a state of predictability which allows brokers and agents to act with confidence."Founded in 1967, W.

R. Berkley Corporation has grown from a small investment management firm into one of the largest commercial lines property and casualty insurers in the United States.Along the way, we've been listed on the New York Stock Exchange, become a Fortune 500 Company, joined the S&P 500, and seen our gross written premiums exceed $10 billion.Today the Berkley brand comprises more than 50 businesses worldwide and is divided into two segments:

Insurance and Reinsurance and Monoline Excess. Led by our Executive Chairman, founder and largest shareholder, William. R. Berkley and our President and Chief Executive Officer, W.

Robert Berkley, Jr., W.R. Berkley Corporation is well-positioned to respond to opportunities for future growth.

Responsibilities

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.

• Identify, analyze, and conduct thorough investigations of suspicious claims in a timely manner.• Ensure accurate, detailed, and timely interviews are completed on applicable parties.• Evaluate, analyze, verify, and obtain material evidence relevant to the investigation. • Locate, extract, and review data from multiple sources and systems to assist in the course of the investigation to ensure accuracy in findings.• Evaluate and coordinate vendor involvement when deemed necessary by establishing a cost-effective budget when utilizing SIU vendors and experts.• Ensure all investigative findings are properly and thoroughly documented in a timely manner.• Evaluate, determine, and complete referrals to State Insurance Departments, Fraud Bureaus, and NICB when suspicious and fraudulent activity has been identified.• Facilitate and coordinate investigations with external SIU contacts, NICB, Department of Insurance Fraud, and various law enforcement agencies.• Facilitate and maintain effective professional communication by providing best in class service to both internal and external customers.• Develop and present anti-fraud training to claims personnel.• Participate in decision making discussions with Company personnel on cases worked and resolution on investigative results.• 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

• Must have 5 or more years of prior SIU experience handling multi line claims with focus on commercial lines.• Exhibit knowledge of basic insurance principals pertaining to claims processes and procedures.• Knowledge of good faith claims practices.• Demonstrate knowledge of investigative methods in regard to laws, rules and regulations involving insurance fraud • Knowledge of privacy regulations and compliance requirements • Proficiency with MS Office products• Easily adapts to new or changing situations and priorities.• Ability to be flexible and multi-task. • Dedicated to meeting the expectations of internal and external customers.• Strong organizational and prioritization skills• Ability to properly handle sensitive and confidential information.• Ability to work both independently and in a team environment.• Demonstrate a strong work ethic with a positive attitude.• Excellent verbal and written communication skills

Education Requirement

• Bachelor's Degree preferred.• Completion of one or more of the following designations: CIFI, FCLS, FCLA, and/or CFE

Responsibilities 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. • Identify, analyze, and conduct thorough investigations of suspicious claims in a timely manner. • Ensure accurate, detailed, and timely interviews are completed on applicable parties. • Evaluate, analyze, verify, and obtain material evidence relevant to the investigation. • Locate, extract, and review data from multiple sources and systems to assist in the course of the investigation to ensure accuracy in findings. • Evaluate and coordinate vendor involvement when deemed necessary by establishing a cost-effective budget when utilizing SIU vendors and experts. • Ensure all investigative findings are properly and thoroughly documented in a timely manner. • Evaluate, determine, and complete referrals to State Insurance Departments, Fraud Bureaus, and NICB when suspicious and fraudulent activity has been identified. • Facilitate and coordinate investigations with external SIU contacts, NICB, Department of Insurance Fraud, and various law enforcement agencies. • Facilitate and maintain effective professional communication by providing best in class service to both internal and external customers. • Develop and present anti-fraud training to claims personnel. • Participate in decision making discussions with Company personnel on cases worked and resolution on investigative results. • 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.