Special Investigations Unit Director jobs in Nebraska

The successful candidate will identify, investigate and respond to potentially fraudulent insurance claims through the use of restricted, subscription-based and public databases, use of private investigators and by other means. The SIU Specialist also will locate and provide information regarding specific vehicles, entities or individuals, and investigate false insurance documents. In addition, this position will provide fraud prevention materials, training and assistance to Claim Examiners, Underwriters and other Company personnel, and will compile information required by insurance regulatory authorities regarding Company fraud prevention activities.

This position will be located in Omaha Nebraska, and hybrid at management discretion.

Essential Duties and Responsibilities:

1. Respond to fraud related inquiries and referrals to SIU from Claim Specialists and Examiners and from automated initial screening system; search restricted, subscription-based and public databases, making maximum use of web-based resources; identify circumstances potentially requiring retention of investigators and/or referral to regulatory or law enforcement authorities; coordinate with independent adjusters, investigators, law enforcement and regulatory authorities, to provide and obtain information for enhanced investigation of particular Claim Files.
2. Review, classify, log and track inquiries and referrals to SIU, applying guidelines to determine whether providing information is sufficient or further SIU action is appropriate.

3. Initiate and complete reporting of suspicious insurance acts to appropriate state regulatory agencies, the National Insurance Crime Bureau and law enforcement, when required.
5. Create and maintain a positive and close working relationship between SIU and Claim Examiners and Claim Specialists; assist in preparing materials and present fraud prevention training to Claims Department and Underwriting units; encourage referrals to SIU of circumstances indicating high potential for fraudulent information or conduct; prepare and distribute information to Claims Department regarding improved claim resolutions resulting directly from Examiner and Specialist referral and inquiries to SIU.
6. Perform data mining of internal systems to detect Insured, Claimant or vendor reporting, payment or other patterns indicating potentially fraudulent information or conduct; identify potentially fraudulent information or activities revealed by inquires and referrals to SIU and in providing appropriate SIU response to all inquiries and referrals.
7. Research, collect and organize claim data and prepare and complete periodic reports required by insurance regulatory authorities regarding fraud prevention activities of primary, BHHC and selected affiliated companies; maintain a comprehensive, well-organized and logically consistent system for recording all significant SIU actions and retaining all SIU-related materials in the ClaimCenter or other appropriate claims management systems, ImageRight and elsewhere; design and prepare charts, spreadsheets, and other visual aids and materials for presentations to management, counsel, law enforcement and regulatory authorities regarding general and specific SIU activities; review, approve within authority, and pay bills from investigators/vendors retained by SIU.
8. Perform other duties as assigned.

Qualifications:

Bachelor Degree or equivalent

Investigation through web-based resources or otherwise

1 to 2 years related work experience

Excellent oral and written communication

Evaluation and analysis

Maintain strict confidentiality

Work independently within established authority

Analyze data, apply knowledge and logic, and draw conclusions

Set priorities, manage time, make decisions, and meet deadlines

Works well with others.