Description

The claims services department has an immediate opening for someone who can demonstrate the WCF values to join their team as a SIU Desk Investigator. This is a full-time, exempt position that works out of WCF’s Sandy, Utah headquarters. This posting is open to internal and external candidates.

 Responsibilities 

• Conducts and assists others in conducting thorough, timely, efficient, and impartial investigations to accurately resolve inconsistent or questionable situations for Claims and other departments, consistent with WCF’s core values and best practices.
• Reviews and analyzes vast amounts of information and data to independently determine direction and extent of needed investigation, and then effectively and efficiently accomplishes that investigation.
• Provides investigative expertise in directing and conducting investigations.
• Gather information from written and computerized records.
• Conducts interviews with people identified as participants in the action under investigation.
• Obtains and serves investigative subpoenas.
• Ability to testify in court, participate in Examinations Under Oath, and is present for depositions, court hearings and trials as appropriate.
• Assists adjusters and other staff in educating about fraud detection, reporting, and referring claims.
• Maintains a high level of current technical knowledge necessary for accurate, timely and efficient claims investigation.
• Coordinates internally with legal, underwriting, adjusters, finance, auditing and WCF policyholders.
• Coordinates externally with surveillance contractors, policyholders, claimants, service providers, medical professionals, body shops, salvage yards, law enforcement officials, attorneys, vendors, other insurance companies, and the State Insurance Fraud Unit and Deputy Attorney General in the prosecution of fraudulent cases.

Requirements

• Two or more years special investigation insurance claims experience, law enforcement, medical background, claims examiner, or similar related work experience preferred.
• Strong organization, analysis, investigation, and decision-making skills
• Strong interpersonal, communication, negotiation, and interview skills.
• Excellent discerning and analytical abilities, with significant attention to detail.
• Excellent capability of independent planning and initiative with little supervision required.
• Ability to read, interpret, and analyze policies as well as state and local statutes.
• Ability to deal with a variety of personalities and maintain high-quality working relationships with individuals from various educational levels and backgrounds.
• Ability to manage complex fraud cases or ring investigations.
• Proficient at internet, social media, and other electronic investigations.
• Experience in fraud data analytics preferred.
• Designation in CIFI, CFE, FCLS or FCLA is preferred.
• Proficiency in use of computer databases, word processing software, keyboarding, electronic communication, fraud detection software, and Internet research capabilities.
• Bachelor’s degree in criminal science, business or related degree, or equivalent experience.