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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.