SIU Analyst/Desk Investigator

POSITION SUMMARY:

This position will conduct analytical research to identify trends and patterns in suspicious claim activity. Activities include acquiring and analyzing complex intelligence and investigative data, using deductive reasoning and compilation/organization of investigative facts to create reports and presentations for various audiences. This position is based in the Boca Raton Office with limited desk investigation responsibilities and reports to the SIU Manager.

ESSENTIAL FUNCTIONS:

• Prioritize and identify patterns and trends using claims and policy data
• Collect, analyze, evaluate, and disseminate data to discover developing patterns, trends, and changes in suspicious activity
• Perform strategic and prescriptive analyses using statistical analysis, time series analysis, link analysis and other tools to view, evaluate and generate conclusions
• Prepare reports that clearly convey insight gained from analysis
• Stratify and classify data and maintain intelligence information for use by SIU staff
• Create visualizations of data for purposes of data exploration
• Prepare charts, diagrams, timelines, or other materials to support analytic findings
• Assist SIU investigators with criminal intelligence and data of known trends and other suspicious activity developed from in house claims reviews as needed
• Participate in investigative strategy development
• Partner with SIU team to formulate strategic plans for investigating organized fraud rings
• Maintain current knowledge of industry trends and tactics used by organized fraud rings to defraud insurers
• Conduct investigations and basic background checks

• Develop and maintain industry, federal, state, and local government contacts involved in fraud investigation, detection, and prevention.
• Attend monthly and quarterly meetings to increase industry awareness and keep management informed of developments that impact claim results in specific regions.
• Manage record keeping of all judgements and restitution orders to include contacting the appropriate State Attorney to represent FPI as a victim
• Respond to any requests for restitution amounts in anticipation of an order and to follow up and coordinate such payments with Accounting and or defense counsel to ensure collection
• Maintain records relating to chain of custody documents within Share Point
• Identify and facilitate the organization of Anti-Fraud Awareness events and create in-house presentation on a specific subject and matter relating to fraud.
• Maintain and pursue technical competencies and continuing fraud education within area of specialization through insurance fraud seminars and other company sponsored courses at the direction of Special Investigations Unit Leadership.

REQUIREMENTS

• 1-3 years in an insurance operation roles such as claims
• 2-5 years in a formal analytical role such data analyst, statistician, etc.
• Bachelor’s Degree in Criminal Justice preferred
• Knowledge of insurance claims process and or investigation of insurance schemes
• Demonstrated ability to acquire, analyze and interpret information from various sources and formulate theories regarding trends and patterns required
• Proven excellence in critical thinking and conceptual skills; creative use of varied research methods
• Competency in conducting internet investigations
• Reasonable knowledge of evidence gathering techniques
• Proficiency with MS Office including Excel, Word, PowerPoint and Access
• Knowledge of statistical, time series and link analysis
• Bilingual (English/Spanish) preferred