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POSITION SUMMARY: The position is responsible for conducting in-depth field investigations of suspicious property insurance claims in a personal lines and commercial lines environment. This includes the investigation of low to moderately complex, suspicious or unlawful activity directed at policyholder and corporate assets in a prompt and expeditious manner. Incumbents in this level are expected to be fully qualified and competent to perform insurance claim investigations. ESSENTIAL FUNCTIONS: THE FOLLOWING ARE THE USUAL, BASIC AND ESSENTIAL FUNCTIONS OF THE POSITION. THESE FUNCTIONS ARE NOT TO BE CONSTRUED AS AN EXHAUSTIVE LIST OF ALL RESPONSIBILITIES, DUTIES, AND SKILLS REQUIRED. • Independently investigates claims involving suspicions of insurance fraud and other irregularities in accordance to Citizens Property Insurance Companies core performance values and best practices; conducts low to moderately complex investigations with minimal directions.
• Prioritizes assignments and conducts necessary field work; exercises independent judgment, initiative and decision making when performing investigations.
• Analyzes facts and data, conducts recorded interviews, prepares investigative reports, and recommends investigative direction to claims adjusters and managers as appropriate.
• Provides support to claims partners and other departments of the corporation, which may include identifying training needs; participation in developing and presenting training and mentoring of external business partners and internal staff to raise fraud awareness and invigorate quality SIU referrals.
• Regularly attends/initiates meetings with claims management. Keeps management informed of developments that impact claims results in assigned region / territory.
• Develops and maintains industry, federal, state and local government contacts involved in fraud investigation, detection and prevention.
• Maintains and pursues technical competency continuing fraud education within area of specialization through insurance fraud seminars and other company sponsored courses at the direction of Special Investigations Unit Leadership.
• May participate in catastrophe response event
• Perform other essential duties as assigned. REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES: • Ability to work independently with minimal supervision and manage a high volume of assignments.
• Strong analytical, verbal and communication skills
• Time Management / Self Motivated
• Computer skills.
• Customer Service and relationship/team building.
• Analytical skills and ability to make deductions; logical and sequential thinker
• Knowledge of available resources (internal and external) to assist in investigations
REQUIRED EDUCATION AND EXPERIENCE:
• Two year degree in Criminal Justice/Corrections, business administration or related field or equivalent years in college education and experience relevant to position.
• 4 plus years combined SIU/investigative experience and property/casualty claims experience
PREFERRED QUALIFICATIONS:
• Bachelor’s degree preferred
• Industry certification, (CIFI, FCLS)
• Bilingual (English/Spanish).
• Comprehensive knowledge of interview and evidence gathering techniques.
PHYSICAL REQUIREMENTS:
This position requires the ability to conduct field work on a regular basis and be able to work a flexible schedule. Ability to sit for long periods of time, hear and converse over the telephone, and key frequently on a computer. Position also requires the ability to be mobile, operate a motor vehicle, inspect physical damage and work in a highly energetic and flexible work environment. Position also requires ability to travel overnight on a limited basis.
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