Claims SIU Consultant

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Act as the primary point of accountability for fraud detection and management strategies across Workers’ Compensation, General Liability, Commercial Auto, Builders Risk, Inland Marine, and Property lines.

• Establish direction and priorities for the SIU program in collaboration with Claims leadership.

• Report on program performance, trends, and recommendations to senior leadership.

• Detect cross-line fraud patterns, referral trends, and emerging investigative requirements.

• Oversee and maintain relationships with SIU vendors, including quality assessments of referrals, invoice and cost auditing, tracking service-level performance, and conducting periodic vendor reviews.

• Develop and uphold a quality assurance framework for SIU referrals and investigative results.

• Create and sustain a methodology for tracking referral outcomes and savings for quarterly and annual ROI reporting.

• Generate regular reports detailing referral volume, cost per referral, outcome types, line-of-business distribution, and additional metrics.

• Collaborate with Underwriting on identifying fraud indicators related to front-end processes, premiums, and new markets.

• Design and implement fraud-recognition training for claims adjusters and underwriting personnel.

• Develop and uphold referral guidance, job aids, and procedures for adjusters.

• Ensure compliance with state-specific SIU and antifraud-plan reporting obligations and mandatory referral processes.

• Stay informed of SIU/antifraud requirements and assist in maintaining a compliance matrix for the company’s operations across multiple states.

• Report directly to the Vice President of Claims.

⛳️ Requirements

• A Bachelor's degree is preferred.

• At least five (5) years of relevant experience in claims, SIU, or fraud investigation, or a comparable combination of education and experience.

• Experience in Law Enforcement is advantageous.

• Proven experience in managing or overseeing vendor relationships of significant scope and cost, including invoice auditing and performance assessment.

• Familiarity with insurance fraud statutes and SIU/antifraud regulatory frameworks, including the NAIC Insurance Fraud Prevention Model Act and associated SIU Model Regulation.

• Evidence of ability to create tracking methodologies and convert claims data into defensible, decision-ready reports.

• Excellent verbal and written communication skills.

• Capability to train adjuster personnel and consult effectively with Underwriting.

• Demonstrated sound judgment, initiative, and the ability to work independently as an individual contributor.

• Willingness to travel 10–15% for vendor site engagement, industry conferences, and state regulatory matters.

• Occasional travel for vendor relationships and compliance is required.

🏝️ Benefits

• Competitive salary along with a performance-based bonus program.

• Three weeks of paid time off (PTO) to begin, plus an additional day off for your birthday.

• A standard 37.5-hour workweek, with Fridays concluding at 2:30 PM.

• Opportunities for professional development through Builders University.

• Recognition of Everyday Wins with company swag and additional time off.

• Eight paid Volunteer Time Off (VTO) hours to contribute to community service.

• Comprehensive benefits designed to support your current well-being and future health.

• Flexibility to work remotely from a home office.

• Virtual collaboration opportunities with the team.

• Participation in company events and meetings.