Permanent General Companies, Inc.

SIU Desk Investigator

US-TN-Nashville
2 weeks ago(1/8/2018 2:11 PM)
# Positions
1
Category
Claims

Overview

Permanent General Companies, also known as "The General" Insurance Company as seen in national television advertisements, is a rapidly growing company and a leading non-standard auto insurance provider.

Currently, we are seeking qualified applicants for Special Investigator I. We offer an employee-friendly and collaborative environment where the right candidate will learn and grow with the company.

 

The General® offers a generous benefits package to its employees including medical, dental, vision and life insurance after one month of employment; health care and dependent care flexible spending accounts, tuition reimbursement, paid time off (vacation, sick, holidays), 401(k) participation with a matching contribution, wellness initiatives and much more!

Responsibilities

Review, Analyze and investigate suspect claim activity utilizing approved SIU investigative vendors.  Plan and supervise investigative activities through effective and efficient supervision of Investigative Vendors according to best practices, complete reports and report status and results to the claims organization in an accurate, timely and efficient manner. 

 

Essential Job Responsibilities
 

  • Investigates assigned claims suspected of insurance fraud and other irregularities; conducts timely, thorough, and accurate inquiries of the relevant facts necessary to support the Claim Adjuster’s decisions.  Maintains assigned claim files in a confidential manner; documents all relevant facts pertaining to those files. 
  • Investigative tasks include but are not limited to;  planning and supervising vendor investigative activities; including taking detailed recorded statements from insured’s, claimants and witnesses, inspecting documents, proper collection of evidence and submission to forensic laboratories for analysis, review and analysis of medical treatment protocols and billing,  collection and analysis of  background information concerning claim parties utilizing databases, law enforcement agencies, public records and other available sources.
  • Provide adjusters and claim supervisors with regular updates regarding status of investigations in accordance with SIU Best Practices.  Complete investigative summary reports detailing the relevance of the findings to the loss.  Ensure that investigative vendors submit thorough final reports regarding their findings according to established deadlines.
  • When suspected fraud is detected, submit thorough report regarding details of the incident and the investigation to appropriate state department of insurance in the manner prescribed by that jurisdiction.   Regularly work and coordinate findings with law enforcement officials, where and when necessary and authorized in accordance with Best Practice Acts, State regulation, and fair claims practice acts.
  • Coordinate and consult with legal department on claim investigations and assign and coordinate and/or conduct Examinations under Oath when appropriate.
  • Prepare required notification to Department of Insurance regarding claims that are being investigated for possible fraud in accordance with that states regulatory requirements. 
  • Prepare status reports for management according to pre-determined deadlines.
  • Maintain company issued equipment.
  • Testifies in civil and criminal courts.
  • Other duties as assigned.

Qualifications

Three to five years of claims investigation experience within a Special Investigation Unit required.  Preferred candidate will have prior investigative experience in either a military investigations, law enforcement, claims fraud  investigation role,  prior investigative interviewing training from Reid School of Interviewing, Investigative Discourse Analysis, FCLA, FCLS, ACFE Designation or similar documented certifications or discipline highly preferred.   Bi Lingual abilities preferred.   Must interact with and provide ongoing training to claims staff, and be able to develop contacts with local fraud bureaus, district attorney office’s, law enforcement agencies, insurance associations, etc.

 

Education Requirements
 

Bachelor’s Degree or a related field or equivalent work experience required.  Extensive investigative background a plus.  

 

Must have a valid driver’s license.

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