We are looking for a dedicated SIU Investigator Senior - Major Case Unit. Within defined guidelines and framework, you will help protect USAA and our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact to USAA. This may involve working with Legal Counsel, government agencies and outside consultants in compliance with state laws and regulations for an assigned operational specialty team.
This is a Remote eligible position. This is a field-based role that can be based in anywhere in the Continental United States.
Relocation assistance is not available for this position.
Responsibilities
Leads the execution of fraud prevention strategies and investigative operations.
Applies 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.
Applies advanced knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
Processes 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.
Makes appropriate and prompt decisions to identify potential complex fraud within defined guidelines.
Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results and outcome of the investigation.
Serves as subject matter authority for team members including providing expert mentorship and training for fraud investigations.
Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.
Develops proactive actions and conveys compelling arguments to influence disposition of arbitrated and litigated cases effectively and efficiently.
Handles CAT duty responsibilities as business requires.
Ensures risks associated with business activities are effectively identified, measured, supervised, 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 skilled investigator with experience taking sophisticated statements from multiple parties to an event.
Ability to capture broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.
Demonstrated ability to coordinate 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:
At least 5 years of SIU/investigative experience in P&C
3+ years of experience conducting multi-claim major case investigations in multiple jurisdictions
Experience with Major Case investigations in more than one line of business (for example, auto/property/casualty)
Experience handling Major Case Investigation from start to finish with advanced report writing to submit for affirmative litigation.
Comprehensive experience applying various causes of action for potential affirmative fraud litigation
Experience working on projects within SIU
Experience leading or mentoring other SIU investigators
Subject Matter Exper
Benefits
Remote work options
Additional Information
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.
We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs.
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