Workers Compensation SIU Field Investigator

Workers Compensation SIU Field Investigator 

Job Title:                            Workers Compensation SIU Filed Investigator

Area of Interest:              Insurance-Claims-SIU

Countries:                          USA

State:                                  New York

 

Job Description:

Chubb is currently seeking a Workers Compensation SIU Field Investigator to join our team working in the State of New York.  This individual will be responsible for investigating Workers Compensation claims to assist our team in making informed claim decisions.

Position Responsibilities:

As a critical part of the Workers Compensation Claim discipline, this position is responsible for collaborating with internal and external customers to:

 

• Analyze first reports of loss, underlying file material, and/or underwriting file, to determine if claim is suspect or potentially fraudulent.
• Conduct a complete, in-depth investigation to develop sufficient evidence to make the appropriate claim handling decision.
• Recommend a final course of Claim action including the substantiation of legitimate claim, or denial of an unjustified claim, and/or a recommendation of further punitive action to successfully execute the above.
• Collaborating and communicating with the following during the investigation: Claim Department, Claim Operations, Loss Control Department, Underwriting Departments, Agents,  Defense Counsel, Insured’s, SIU Manager, Law Enforcement, Regulatory Agencies, and Industry Anti-Fraud Organizations
• Establishing strong business relationships and delivering exceptional customer service.
• Maintaining and monitoring an active diary, properly documenting all developments in claim file, preparing investigative reports, maintaining suspicious claim database, and preparing reports on a quarterly basis to SIU management.
• Be familiar with and adhere to all State fraud statutes.
• Actively pursue memberships in professional Anti-Fraud investigative organizations and participate in associated training and events offered.
• Develop and provide fraud awareness training to internal and external customers.

 

Knowledge & Skills:

• Candidate should possess a minimum of 5 years of experience as an Investigator with an insurance carrier, law enforcement or the US military.  Workers Compensation insurance investigation experience is a plus.   
• High level of acumen in the areas of investigation, listening, strategic/analytical thinking, problem solving, and innovative thinking
• Strong knowledge of general industry trends and legislative activities regarding fraudulent claim handling, tort reform, fraud statutes, and civil/criminal procedures
• Clear interest in and quality execution of "deeper" level investigations
• Strong interpersonal/ relationship skills- proven ability to build and maintain excellent customer relationships in all situations; success with being a positive "face" to customers; ability to investigate through relationships; acumen to build and maintain successful relationships with internal colleagues as well as local law enforcement, attorney general employees, and insurance bureaus.
• Proficiency with Microsoft Outlook, Microsoft Word, Microsoft Excel is needed. 
• The candidate must have excellent verbal and written communication skills.

 

 

Knowledge & Skills:

• Candidate should possess a minimum of 5 years of experience as an Investigator with an insurance carrier, law enforcement or the US military.  Workers Compensation insurance investigation experience is a plus.   
• High level of acumen in the areas of investigation, listening, strategic/analytical thinking, problem solving, and innovative thinking
• Strong knowledge of general industry trends and legislative activities regarding fraudulent claim handling, tort reform, fraud statutes, and civil/criminal procedures
• Clear interest in and quality execution of "deeper" level investigations
• Strong interpersonal/ relationship skills- proven ability to build and maintain excellent customer relationships in all situations; success with being a positive "face" to customers; ability to investigate through relationships; acumen to build and maintain successful relationships with internal colleagues as well as local law enforcement, attorney general employees, and insurance bureaus.
• Proficiency with Microsoft Outlook, Microsoft Word, Microsoft Excel is needed. 
• The candidate must have excellent verbal and written communication skills.

 

Travel:

• Yes, 50% of the time.