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Open nowPosted 594 days ago

Claims Investigator

siuconsultantgroup2 open roles

Pay
$157,884 – $189,482 a yearly
Where
Pleasanton, CA
Work mode
Hybrid
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Your applicationOpen nowClaims Investigatorsiuconsultantgroup · Pleasanton, CA

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The clock on this job

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12.3% of postings close within 7 days. Measured by our own scanner across the market.

Share of postings closed within
  1. 2.1%1 day
  2. 4.5%3 days
  3. 12.3%7 days
  4. 19.3%14 days
  5. 35.6%30 days
  6. 57.8%60 days
This job: posted 594 days ago

The posting

SIU Consultant Group is a full service investigation firm providing superior investigation services to employers, insurance carriers, public entities, third party administrators and legal counsel. With over 25 years of experience, SIU Consultant Group's proven processes exceeds the industry standards by providing superior service, cost savings and results.

We are looking for a diligent, detail-oriented Claims Investigator to join our team. As a Claims Investigator for our Security and Investigations Company, you will be responsible for conducting thorough investigations into claims made by individuals or organizations. The role requires analyzing evidence, interviewing witnesses, gathering statements, and collaborating with various stakeholders such as employers, insurance carriers, legal counsel, and third-party administrators. The ideal candidate will possess strong investigative skills, critical thinking abilities, and a keen eye for detail in uncovering the truth behind claims.

Responsibilities:

  • Claims Investigation: Investigate claims involving workers' compensation, insurance fraud, personal injury, and other related incidents by gathering facts, reviewing documents, and conducting interviews with involved parties.
  • Evidence Gathering: Collect and analyze physical, digital, and documentary evidence to determine the validity of claims. Ensure all evidence is documented in accordance with legal and company guidelines.
  • Interviewing: Conduct interviews with claimants, witnesses, employers, and other involved parties to obtain statements and gather information relevant to the investigation.
  • Report Writing: Prepare detailed, clear, and concise investigative reports, summarizing findings, evidence, and conclusions. Ensure reports are submitted in a timely manner and adhere to the company's reporting standards.
  • Surveillance: Conduct surveillance as necessary to gather additional information to support or refute a claim, ensuring all activities are conducted within legal and ethical boundaries.
  • Collaboration with Stakeholders: Work closely with clients, including insurance carriers, third-party administrators, and legal counsel, providing updates and sharing investigation results to support decision-making and claims resolution.
  • Case Management: Manage multiple investigations simultaneously, ensuring that each case is followed through from initiation to resolution while meeting deadlines.
  • Compliance & Legal Adherence: Ensure all investigations comply with relevant laws, regulations, and industry standards, including maintaining confidentiality and protecting sensitive information (e.g., adhering to privacy regulations such as HIPAA).
  • Fraud Detection: Recognize signs of fraudulent claims and take appropriate action to report potential fraud to the relevant authorities or insurance companies.
  • Continuous Learning: Stay up-to-date with industry trends, investigative techniques, and legal regulations to enhance the quality of investigations.

Requirements:

  • Experience: At least 3 years of experience in claims investigation, security, or a related field, ideally within the insurance or legal sectors.
  • Education: A bachelor’s degree in criminal justice, law enforcement, security studies, or a related field is preferred.
  • Licensing/Certifications: Relevant certifications.
  • Knowledge: Familiarity with claims processes, legal proceedings, and industry regulations (such as insurance laws, workers' compensation regulations, or privacy laws).
  • Problem-Solving Abilities: Ability to think critically and solve problems in high-pressure situations.
  • Ethics & Integrity: Demonstrated ability to handle sensitive information with integrity and discretion, adhering to ethical standards.
  • Surveillance & Fieldwork: Comfort with fieldwork, including conducting surveillance and interviews in various settings.

Benefits:

  • Competitive Salary: A competitive salary with performance-based incentives and bonuses.
  • Health Benefits: Comprehensive medical, dental, and vision insurance plans to ensure your well-being.
  • Retirement Plans: 401(k) plan with company match to support your long-term financial security.
  • Paid Time Off: Generous paid time off, including vacation, personal, and sick leave, as well as paid holidays.
  • Work-Life Balance: Flexible working hours and the possibility for occasional remote work, depending on the nature of the investigation.
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