UPC Insurance

  • SIU Investigator

    Job Locations US-SC-Charleston
  • Overview

    Summary: Provide specialized investigative and advisory services, particularly when claim or underwriting fraud is suspected. Develop innovative and long-term fraud detection and prevention programs. Support public entities and other industry groups in prosecution of insurance fraud.

    Responsibilities

    Essential Duties/Responsibilities:

    • Demonstrates an ability to successfully investigate common fraud schemes and develops investigative strategies.
    • Reviews initial referrals, evaluates claim and underwriting information to identify appropriate resource and investigative strategies.
    • Develops and presents verbal and written investigative and management reports.
    • Serves as a resource to team members. Assists in the delivery of fraud awareness training initiatives throughout UPC Insurance.
    • Consistently manages workload to maximize capacity. Participates in planning and business meetings.
    • 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:

    • Six months of P&C claims adjusting OR 2 years law enforcement, investigative 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.
    • Organization skills; Business math Skills; Business telephone skills.
    • 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.
    • On-going continuing education as required by state regulations.
    • Knowledge of claims handling, state laws, compliance requirements and insurance regulations.
    • Minimum of six months 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.
    • 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.
    • Ability to adapt to new situations and learn quickly.

    Other Abilities/Skills: 

    • Desire to seek industry certifications as needed.

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