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For a national
listing of Insurance Fraud investigator positions, please go to
the
International Association of Special Investigations Unit.
Please note that Puget Sound
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Posted: April
24, 2008

Job Title:
SIU
Analyst
FLSA Status:
Exempt
Reports To:
SIU
Manager
Approved Date: 4/15/2008
Location: Based in
Field Claims Offices located in Atlanta, Dallas, Denver,
Madison, New Jersey, New York, Phoenix, Sacramento, or Tampa.
This position will report to Bruce Raines, the national SIU
Manager (Madison, WI).
Summary
The SIU Analyst
will work directly with SIU Investigators, Managers and Senior
Management. The Analyst will have responsibility for the
quality and outcome of their investigative work product as part
of the complete investigation conducted by the SIU Investigators
and Managers. The job will encompass proactive and ongoing
analytical work including special projects directly related to
SIU handling.
Job
Responsibilities:
·
Data research projects to include analysis of data with a
finished written report for SIU complex case investigations
·
Complete and present cases to District Attorney’s for
prosecution in conjunction with an SIU Investigator or Manager.
·
Participate in NICB task force projects
·
Testify in court on case specific SIU Analyst work
·
Management of fraud detection software applications, utilization
and implementation within the claim process.
·
Proactive data searches to locate claims with a probability of
suspicious activity using fraud detection software and/or
advanced data pulls from in house and subscribed data services.
·
Quantification of company exposures to subject(s) under
investigation.
·
Working directly with SIU Senior Management in project study,
analysis and completion
·
Daily database runs, analysis of data and written report of
findings to SIU Management and Investigators.
·
Provide training to Claims and SIU regarding outcomes of
investigations and studies
·
Maintains a rapport with industry peers, law enforcement,
vendors and industry experts
·
Other duties as assigned
Qualifications:
·
SIU Analyst or SIU Investigator experience required
·
Proficiency in all Microsoft applications
·
Demonstrated ability in data transfer, mining and research
techniques
·
Broad knowledge on how to access, secure and process public
records via the internet and/or state specific public record
·
databases.
·
Knowledge of medical terminology, CPT, E/M & ICD-9 codes and
billing application
·
Knowledge of the Corporate Practice of Medicine doctrine, state
laws regarding medical treatment delivery, licensing and
·
regulation.
·
Familiar with Body Shop estimating and billing
·
Familiar with Auto Insurance Industry databases
·
Familiar with Fraud Modeling software
·
Advanced organizational skills
·
Ability to interface within all levels of the organization
·
Strong analytical skills providing concise detailed outcomes
·
Works independently and within a team environment
·
Multi-tasker who can meet deadlines and works well under
pressure
·
Excellent verbal, written, and interpersonal skills
·
Ability to learn new computer technology
·
Familiar with Insurance terminology
·
Familiar with Claims Systems
·
Knowledge of phone and internet conference calling systems
Education
and Experience:
·
BA
degree or significant work experience under all qualifications
Physical Demands
& Work Environment
Representative
of those that must be met by an employee to successfully perform
the essential functions of this job. Must be able to operate a
PC and sit for extended periods of time. Reasonable
accommodations may be made to enable individuals with
disabilities to perform the essential functions.
This position
description intends to describe the general nature and level of
work being performed by people assigned to this job. It is not
intended include all duties and responsibilities. The order in
which duties and responsibilities are listed is not significant.
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