POSITION SUMMARY:

Reports to SIU Manager, position will conduct analytical research to identify trends and patterns of suspicious claim activity.  This position is responsible for acquiring and analyzing complex intelligence and investigative data, using deductive reasoning and compilation/organization of investigative facts.  This is a remote mid-level remote position located in the Boca Raton Office with some travel required.

ESSENTIAL FUNCTIONS:

• Responsibilities include the ability to review, analyze, triage, and manage investigations within the SIU databases. Update and maintain all statistics/metrics associate with SIU referrals and investigations. Collect, collate, analyze, dissemination and evaluate data used to discover developing patterns trends and changes in suspicious activity. Perform strategic, prescriptive analysis using statistical data, time series analysis, link analysis, maps, and other tools to view, evaluate and generate conclusions.  Prepare written reports, to include visualizations of data for purposes of data exploration and to gain insight through analytics.  Prioritize and Identify patterns and trends of suspicious activity or other indicators.  Stratify and classify data and maintain intelligence information for use by SIU staff.  Assist SIU investigators with criminal intelligence and data when applicable. Identify known trends and other suspicious activity developed from in house claims reviews and analysis.  Participate in investigative strategy development meetings.  Interact with others within the organization to secure and coordinate data/information necessary to formulate a strategic plan for investigating organized fraud rings/trends.  Conduct basic background investigations to include social media and other platforms.  The ability to work with other departments and respond to questions and inquires. 

• Responsible to generate and respond to immunity request from other carriers.  Maintain chain of custody documents, judgements, and restitution orders within our databases. Respond to and calculate requests for restitution, record and coordinate restitution payments with accounting and update database records.

Identify, contribute, and participate in the organizing Anti-Fraud Awareness events, including the creation of in-house presentations.  Develops and maintains industry, federal, state, and local government contacts involved in fraud investigation, detection, and prevention. Attend monthly and quarterly meetings and keep management informed of developments that may impact claim results in specific regions.  Participate in discussion and increase industry awareness.  Maintain and pursue technical competency relating to fraud awareness and education through insurance fraud seminars and other company sponsored courses at the direction of Special Investigations Unit leadership. Understanding of statutes and laws that impact the SIU community and as it relates to investigations.

REQUIRED EDUCATION AND EXPERIENCE:

• Knowledge of insurance claims process and or investigation of insurance schemes 1-3 year within insurance operation roles such as claims 2-5 years with a formal analytical role (data analyst, statistician) Proficiency with Excel, Word, and Power Point Knowledge of statistical, time series and link analysis Bilingual (English/Spanish) a plus Reasonable knowledge of evidence gathering techniques

PREFERRED QUALIFICATIONS:

• Strong analytical skills

• Self-Motivated Strong organization and time management skills Strong written and verbal skills

Technical skills

• The ability to accurately maintain data and records Proven ability to acquire, analyze and interpret information from various sources and formulate theories regarding trends and patterns required. Proficiency with Microsoft Office Suite particularly Excel/PowerPoint/Teams, Canva & Share Point The ability to perform internet research Knowledge of related analytical and statistical techniques