Field SIU Adjuster

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

📋 Description

• Investigate and assess intricate, multi-disciplinary coverage and claims referred to the Special Investigation Unit for possible fraud.

• Perform background checks, scene investigations, clinic assessments, recorded statements, witness interviews, and social media inquiries.

• Conduct surveillance on properties and create scene reconstructions for select investigations.

• Evaluate whether fraud can be substantiated and provide support for lawsuits.

• Input SIU claim data into various SIU systems.

• Review investigations with fraud outcomes to determine if denial is justified.

• Update files with investigation results and return them for additional processing if fraud or sufficient evidence is not identified.

• Execute complex online data searches, research, assessments, and site inspections.

• Decide if payment is justified on potentially fraudulent claims.

• Verify information gathered through investigations and pursue potential leads.

• Summarize documents and record claim files with notes, evaluations, and decision-making processes.

• Utilize analytical tools and SIU field intelligence to identify complex claims and substantiate evidence of fraud and damages.

• Research and address complex customer inquiries, concerns, conflicts, or issues.

• Provide work guidance, mentoring, and coaching to junior employees and the team.

⛳️ Requirements

• A minimum of 2 years of experience is preferred.

• Strong analytical thinking skills.

• Experience in claims processing.

• Proficient in critical thinking.

• Skilled in documentation practices.

• Experience in evidence gathering.

• Background in fraud investigations.

• Capable of information collection.

• Familiarity with insurance claims investigations.

• Experience in insurance investigations.

• Proficient in investigative interviewing techniques.

• Experience with surveillance.

• Authorized to work in the United States; visa sponsorship is not available.

• A dedicated, distraction-free home workspace is required.

• Reliable internet connection with minimum speeds of 50 MB download and 5 MB upload.

🏝️ Benefits

• Comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse.

• Monthly connectivity reimbursement to help offset internet expenses.

• Ability to work remotely from home.

• Equal Opportunity employer.

• Assistance or accommodation in completing the online application.