SIU Investigator Senior - Major Case Unit - Field – New York or New Jersey

Why USAA?

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.

The Opportunity

As a dedicated Senior SIU - Major Case Unit Investigator, you will within defined guidelines and framework, protects USAA and our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact to USAA which may involve Legal Counsel, government agencies and outside consultants in compliance with state laws and regulations for an assigned operational specialty team.

What you'll do:

• Lead the execution of fraud prevention strategies and investigative operations.
• Lead high exposure, high profile and sensitive work assignments, and special investigations involving complex specialized fraud referrals, (examples: organized provider rings, staged accidents, large losses of significant exposure and broad scale PIP/Casualty Schemes) across multiple entities or functions.
• Apply advanced knowledge of P&C insurance industry products, services, and processes in investigating claims. This includes P&C insurance policy contracts and coverages and claims handling process and procedures.
• Apply advanced knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
• Process large quantities of unstructured detailed information with high levels of accuracy by collecting evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.
• Make appropriate and prompt decisions to identify potential complex fraud within defined guidelines.
• Prepare and presents detailed and comprehensive verbal and written investigative reports summarizing the results and outcome of the investigation.
• Serve as subject matter expert for team members including providing expert guidance and training for fraud investigations.
• Develop and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.
• Develop proactive actions and conveys compelling arguments to influence disposition of arbitrated and litigated cases effectively and efficiently.
• Handle CAT duty responsibilities as business requires.
• Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

What you have:

• High School Diploma or General Equivalency Diploma.
• 4 years of P&C SIU/Fraud investigation experience; OR 6 years relevant fraud industry investigation experience.
• Expert knowledge and understanding of fraud investigations as well as application of case law and state laws and regulations.
• Must be a results-oriented, skilled investigator with experience taking complex statements from multiple parties to an event.
• Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.
• Demonstrated ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems.
• Experience using computers and various software packages to enter and extract data for analysis from relevant data sources and systems.
• Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.
• Experience in concurrent handling of specialty/complex/litigated claims/cases as well as mediation/arbitration/trial preparation and participation.

What sets you apart:

• 3+ years of experience conducting multi-claim major case investigations in multiple States.
• Comprehensive experience applying various causes of action for potential affirmative fraud litigation.
• Experience with Major Case investigations in more than one line of business (for example, auto/property/casualty).
• Experience working in projects within SIU.
• Experience leading or mentoring other SIU investigators.
• Subject Matter Expertise (SME) in at least one personal line of business (auto/property/casualty).
• At least 5 years of SIU/investigative experience in P&C.