United Auto Insurance
Investigator II - Special Investigation Unit - Miami, Florida
United Auto Insurance, Miami, Florida, us, 33222
COMPANY OVERVIEW:
Founded in 1989, United Automobile Insurance Company (UAIC) is an innovative and established organization looking for an SIU Investigator II to join our team. Family‑owned, UAIC is one of the largest privately held property and casualty insurance companies in the United States. The key to our growth and success is a commitment to providing quality service to our agents and customers by disciplined underwriting and strategic claims handling. Our ongoing efforts to invest substantial resources in personnel and technology ensure maximum efficiency and specialized operations in the industry. We are proud that our independent agents and customers have recognized our dedication by making UAIC the market leader in every state where we conduct business.
This is a remote field position for the Miami‑Dade and Broward County Area.
SCOPE: As an SIU Investigator II, you will conduct field and desk investigations to detect fraud on high‑complexity claims involving staged auto accidents, fraud rings, and questionable medical treatment. You will provide investigative expertise to limit exposure and protect company assets. Investigations involve auto liability private passenger and commercial auto lines for non‑standard policies and may include database searches, examinations under oath, and scene canvasses. Focusing on thoroughness, quality, timeliness, and cost control, you will prepare and submit SIU investigative reports covering all phases of each case for approval. You will maintain continued contact during investigations with supervision, internal legal professionals, external medical professionals, government/regulatory agencies, NICB, law enforcement, and outsourced vendors. The investigator will also effectively carry out investigations of alleged fraud, waste, and abuse by medical providers, body shops, and others.
DUTIES:
Conduct clinic inspections and examinations under oath.
Conduct in‑depth research and review of suspected fraudulent or abusive patterns to develop sufficient evidence to conclusively establish facts involving insureds, claimants, medical and auto body shop providers, or other entities.
Collect, utilize, and interpret data from a variety of computer‑generated reports and other sources; thereby identifying and documenting questionable patterns related to medical modalities, procedures, and other practices which merit further investigation.
Maintain assigned investigation files, document evidence, and prepare comprehensive investigation reports at the completion of each investigation.
Assist in conducting comprehensive interviews with medical and other providers, insureds/claimants in the presence of their attorneys where applicable, and witnesses to obtain statements and information admissible under accepted rules of evidence in civil and criminal court proceedings.
Conduct special projects initiatives/investigations referred by the House Counsel.
Establish and maintain liaison with NICB, law enforcement officers, and others to obtain assistance in conducting, facilitating, and enhancing investigations.
Be knowledgeable about all applicable insurance regulations, especially PIP regulations, to ensure duties and assignments are carried out within the requirements of applicable law and office expectations.
Mentor and teach less experienced investigators, promoting teamwork and collaboration within the department and encouraging sharing of insights, experiences, and best practices within the SIU team.
EDUCATION:
Associate or bachelor’s degree in a related field preferred and/or 5 years of related work experience.
SKILLS & EXPERIENCE:
Bilingual (English & Spanish)
Knowledge of current procedural terminology.
Strong critical thinking and analytical skills with the ability to interpret data and trends.
In‑depth knowledge of applicable fraud statutes, regulations, and industry best practices.
High degree of integrity as demonstrated by appropriate treatment of confidential information, and adherence to policies, rules, and regulations.
Effective communication and interpersonal skills, with the ability to build and maintain relationships with internal and external stakeholders.
Excellent organizational and project management abilities, with a keen eye for detail.
Expert knowledge of medical claims processing and investigations, a strong plus.
Experience in CPT codes and medical terminology highly preferred.
Detail‑oriented investigator with strong organizational and time management abilities.
Analytical and interview skills: ability to make deductions; logical and sequential thinker.
Computer literate; database and Internet proficient. Knowledge of available resources (internal and external) to assist in investigations.
Ability to work with others in a team environment.
BENEFITS:
401(k) Retirement Savings Plan with employer match.
Comprehensive medical, prescription drug, vision, and dental insurance.
Paid Time Off, holidays, and leave programs.
Flexible spending accounts.
Basic life insurance and voluntary life/AD&D.
Short‑term and long‑term disability.
UAIC is an Equal Opportunity Employer and is committed to the principle of equal employment opportunity for all employees. All employment decisions at UAIC are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, belief, family, or parental status, or any other status protected by the laws or regulations in the locations where we operate.
#J-18808-Ljbffr
Founded in 1989, United Automobile Insurance Company (UAIC) is an innovative and established organization looking for an SIU Investigator II to join our team. Family‑owned, UAIC is one of the largest privately held property and casualty insurance companies in the United States. The key to our growth and success is a commitment to providing quality service to our agents and customers by disciplined underwriting and strategic claims handling. Our ongoing efforts to invest substantial resources in personnel and technology ensure maximum efficiency and specialized operations in the industry. We are proud that our independent agents and customers have recognized our dedication by making UAIC the market leader in every state where we conduct business.
This is a remote field position for the Miami‑Dade and Broward County Area.
SCOPE: As an SIU Investigator II, you will conduct field and desk investigations to detect fraud on high‑complexity claims involving staged auto accidents, fraud rings, and questionable medical treatment. You will provide investigative expertise to limit exposure and protect company assets. Investigations involve auto liability private passenger and commercial auto lines for non‑standard policies and may include database searches, examinations under oath, and scene canvasses. Focusing on thoroughness, quality, timeliness, and cost control, you will prepare and submit SIU investigative reports covering all phases of each case for approval. You will maintain continued contact during investigations with supervision, internal legal professionals, external medical professionals, government/regulatory agencies, NICB, law enforcement, and outsourced vendors. The investigator will also effectively carry out investigations of alleged fraud, waste, and abuse by medical providers, body shops, and others.
DUTIES:
Conduct clinic inspections and examinations under oath.
Conduct in‑depth research and review of suspected fraudulent or abusive patterns to develop sufficient evidence to conclusively establish facts involving insureds, claimants, medical and auto body shop providers, or other entities.
Collect, utilize, and interpret data from a variety of computer‑generated reports and other sources; thereby identifying and documenting questionable patterns related to medical modalities, procedures, and other practices which merit further investigation.
Maintain assigned investigation files, document evidence, and prepare comprehensive investigation reports at the completion of each investigation.
Assist in conducting comprehensive interviews with medical and other providers, insureds/claimants in the presence of their attorneys where applicable, and witnesses to obtain statements and information admissible under accepted rules of evidence in civil and criminal court proceedings.
Conduct special projects initiatives/investigations referred by the House Counsel.
Establish and maintain liaison with NICB, law enforcement officers, and others to obtain assistance in conducting, facilitating, and enhancing investigations.
Be knowledgeable about all applicable insurance regulations, especially PIP regulations, to ensure duties and assignments are carried out within the requirements of applicable law and office expectations.
Mentor and teach less experienced investigators, promoting teamwork and collaboration within the department and encouraging sharing of insights, experiences, and best practices within the SIU team.
EDUCATION:
Associate or bachelor’s degree in a related field preferred and/or 5 years of related work experience.
SKILLS & EXPERIENCE:
Bilingual (English & Spanish)
Knowledge of current procedural terminology.
Strong critical thinking and analytical skills with the ability to interpret data and trends.
In‑depth knowledge of applicable fraud statutes, regulations, and industry best practices.
High degree of integrity as demonstrated by appropriate treatment of confidential information, and adherence to policies, rules, and regulations.
Effective communication and interpersonal skills, with the ability to build and maintain relationships with internal and external stakeholders.
Excellent organizational and project management abilities, with a keen eye for detail.
Expert knowledge of medical claims processing and investigations, a strong plus.
Experience in CPT codes and medical terminology highly preferred.
Detail‑oriented investigator with strong organizational and time management abilities.
Analytical and interview skills: ability to make deductions; logical and sequential thinker.
Computer literate; database and Internet proficient. Knowledge of available resources (internal and external) to assist in investigations.
Ability to work with others in a team environment.
BENEFITS:
401(k) Retirement Savings Plan with employer match.
Comprehensive medical, prescription drug, vision, and dental insurance.
Paid Time Off, holidays, and leave programs.
Flexible spending accounts.
Basic life insurance and voluntary life/AD&D.
Short‑term and long‑term disability.
UAIC is an Equal Opportunity Employer and is committed to the principle of equal employment opportunity for all employees. All employment decisions at UAIC are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, belief, family, or parental status, or any other status protected by the laws or regulations in the locations where we operate.
#J-18808-Ljbffr