UPC Insurance

  • SIU Case Manager 1

    Job Locations US-FL-St. Petersburg
  • Overview

    Summary: Coordinate resources to properly investigate external risks associated with organized fraud. Maintain SIU standards, reporting procedures, statutory compliance, and the efficient operation of the assigned team. Coordinate the identification and development of major case investigations with key stakeholders. 

    Responsibilities

    Essential Duties/Responsibilities:

    • Supports the investigative and claims process by leading, guiding and directing investigations including complex cases.
    • Coordinate resources to property investigate external risks associated with organized fraud.
    • Maintain SIU standards, reporting procedures, statutory compliance, and the efficient operation of the assign team.
    • Develops and presents verbal and written investigative and management reports.
    • Serves as a resource and mentor to team members.
    • Assists in the delivery of fraud awareness training initiatives throughout UPC Insurance.
    • Acquires and applies a working knowledge of state laws and regulations pertaining to insurance fraud.
    • Identifies, establishes and cultivates external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection and prevention.

    Supervisory Responsibilities: None

    Qualifications

    Required Skills:

    • Bachelor’s degree or in-lieu of degree equivalent education, training and work-related experience.
    • Licensed Adjuster or ability to obtain an Adjuster License.
    • Good analytical abilities to review, exercise judgment and evaluate information.
    • Very good understanding of the elements of intent, material misrepresentation, intentional acts, aggressive good faith, and jurisdictional immunity statutes.
    • Ability to work independently with self-initiative and limited direction.
    • Excellent communication skills; ability to obtain information from others and deliver information to others orally or in written form.
    • Excellent computer skills are needed due to multiple claim systems, investigative databases, and jurisdictional online reporting requirements.
    • Ability to carry out detailed written or verbal instructions; ability to respond to requests effectively and efficiently. Ability to work effectively without supervision and direction and exhibit good common sense.

    Education and/or Experience:

    • College degree is not a prerequisite for this position; however, incumbents should possess such skills and knowledge as are normally gained in the successful completion of a 4-year college program or equivalent experience.
    • Insurance coursework (I.e. IIA, FCLS, SCLA, CIFI), is beneficial.
    • Knowledge of claims handling, state laws, compliance requirements and insurance regulations.
    • Minimum of three years prior experience in compliance, regulation, SIU or an insurance-related field is beneficial.

    Competencies:

    • Possess a solid command of the claims/SIU policies and procedures; exhibits sound interpretation of polices & procedures in investigating and resolving claims.
    • Ability to serve as an expert of related subject matter.
    • Ability to adjust claims to include, but not limited to writing coverage determination letters.
    • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint).
    • Must possess effective verbal and written communication skills.
    • Must perform well in high-energy, dynamic and team-oriented environments.
    • Effective organization and time management skills with the ability to work under pressure and adhere to project deadlines.
    • Excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization.
    • Demonstrate integrity with a professional environment.

    Other Abilities/Skills:

    • Desire to seek industry certifications as needed.

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed