SIU Investigator Intermediate - Field

📋 Description

• • Investigate questionable or suspect first- or third-party insurance claims to detect and prevent fraud in compliance with state insurance fraud laws and USAA policies.
• • Apply in-depth knowledge of property and casualty (P&C) insurance products, policy contracts, coverages, and internal claims handling procedures to assess claim validity.
• • Conduct field and remote interviews with claimants, witnesses, and suspects to obtain statements and gather evidence of potential fraudulent activity.
• • Utilize investigative databases, internal systems, public records, internet resources, and forensic tools to collect and analyze evidence supporting fraud determinations.
• • Develop and recommend actions within defined authority guidelines based on investigative findings and objective evidence.
• • Prepare detailed, comprehensive written and verbal investigative reports summarizing findings, conclusions, and recommended outcomes for internal review and potential legal action.
• • Build and maintain external relationships with law enforcement agencies, industry partners, and other stakeholders involved in fraud detection and prevention.
• • Participate in the development and implementation of fraud prevention strategies to reduce organizational exposure to fraudulent claims.
• • Serve as a resource team member on complex fraud matters, leveraging specialized skills or training to support investigations.
• • Assist in delivering fraud awareness training initiatives to internal teams and stakeholders within defined environments.
• • Fulfill CAT (Catastrophe) duty responsibilities as required by business needs, including responding to large-scale events with increased claim volumes.
• • Identify, measure, monitor, and control risks associated with business activities in alignment with USAA’s risk and compliance policies and procedures.
• • Ensure all investigations adhere to state and local regulations, legal standards, contract interpretations, case law, medical treatment protocols, and medical terminology.
• • Use computer systems and software applications to enter, extract, and analyze data from multiple sources to support investigative conclusions.
• • Organize and prioritize a high-volume workload, managing multiple concurrent investigations while maintaining accuracy and timeliness.
• • Demonstrate strong problem-solving skills by devising effective solutions to complex fraud scenarios with limited or conflicting information.