SIU Major Case Manager (Medical Provider)

About the role

As a dedicated SIU Major Case Manager (Medical Provider) , you will be responsible for operational management of Claims fraud investigative teams. Directs staff in the investigation of cases involving questionable, suspect, or fraudulent activity. Ensures compliance with policies and procedures contributing to fraud control objectives, as well as compliance with state insurance fraud-related laws and regulations. This role is remote eligible in the continental U.S. with occasional business travel.

Responsibilities

• Responsible for insurance fraud detection and investigation services to reduce fraud-related claim payments and costs, while avoiding unwarranted risk.
• Ensure compliance with laws and regulations relating to claims handling and unfair claims practices and reporting statutes.
• Participates in the establishment and implementation of policies and procedures for fraud control and investigative practices.
• Performs leadership and management tasks, i.e., providing coaching, evaluating performance, review of time sheets, managing time off, conducting quarterly check-ins/ride-alongs, etc.
• Evaluates, authorizes, and implements actions and decisions to carry out proactive claim's projects and investigations.
• Review and evaluate investigation recommendations from investigators to ensure results and case documentation support conclusions.
• 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:
• Bachelor's degree; OR 4 years of relevant education and/or experience.
• 2 years of demonstrated leadership experience, supervisory or management experience in major case medical provider.
• 6 years' experience in medical provider fraud and P&C industry functional work OR 4 years of medical provider P&C experience plus military service experience.
• Experience supporting and developing affirmative litigation referrals and collaborating with counsel on fraud-related legal actions.
• Demonstrated ability to manage multiple high-priority investigations and case assignments simultaneously while meeting critical deadlines.
• Experience handling large-scale, complex, and high-exposure fraud investigations from initial referral through resolution.
• Extensive knowledge and experience in all levels of claims investigation or fraud investigation and regulatory reporting requirements.
• Knowledge of anti-fraud analytics programs relates to fraud prevention and identification.
• Thorough understanding investigative tools and techniques to guide and coach special investigators.
• Demonstrated ability to build and maintain collaborative relationships with internal and external partners and business areas.
• Demonstrated management skills and the ability to demonstrate monthly productivity and cycle time outcomes from investigations assigned to the SIU team.
• Ability to prepare and present training sessions and case outcomes.
• Demonstrated experience facilitating and managing projects and teams
• What sets you apart:
• US military experience gained through military service or gained as a military spouse / domestic partner.
• Compensation range: The salary range for this position is: $119-310 - $228,040 .
• USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).
• Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
• Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.
• The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
• Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, li

Benefits

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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