SIU Specialist - Claims

Tampa
US-FL-Tampa
Category
Claims
Type
Regular Full-Time

Our Company

About Us:

American Integrity Insurance, the premier writer of Florida homeowners insurance, has more than 250,000 customers and is exclusively represented by more than 900 independent agents who specialize in this complex and ever-evolving market. We offer sound and comprehensive home, condo, rental property and manufactured home insurance to families throughout the Sunshine State. Comprised of nearly over 180 insurance professionals, most of whom work in our Tampa-area headquarters, we have been recognized as a Top Place to Work in Tampa by the Tampa Bay Times and a Best Places to Work in Insurance by Business Insurance magazine for the past three years.

 

A Day in the Life:

Who Says Insurance Can’t Be Fun? From company picnics to charity events, no one can ever say American Integrity Insurance doesn’t understand the importance of having fun, helping others and giving back. Our company culture is priceless, and we hold true to our six core values: integrity, commitment, teamwork, humility, passion and fun. As a team working to provide home insurance solutions to our policyholders, together we aim to achieve greater heights each day and celebrate each other's accomplishments along the way. It is our mission to continue providing reliable, customer-centric homeowners insurance to Florida residents and paying claims in a timely manner when our customers suffer a loss – and to do so with Integrity.

 

Learn more about American Integrity Insurance and our job opportunities at www.aiicfl.com.   

This Job

Title: SIU Specialist

 

You'll Report to: Inside Claims Manager

 

The SIU specialist functions as part of designated unit responsible for detection, prevention, investigation, education, correction and resolution of fraud pertaining to business lines.  This position is responsible for triaging, investigating and resolving all instances of potential fraud, which may include, but is not limited to investigations of professionals, non-professionals, property, background investigation, financial forensics related to claims or misappropriation of services, partners, funds or contracted entities.

 

The SIU specialist is expected to receive and thoroughly document all assigned leads, document allegations, develop investigative action plans, refer case information and coordinate with management to ensure proper claim handling.  The SIU Specialist will conduct interviews, collect evidence, prepare case information, negotiate settlement or resolution proposals, develop corrective action plans, participate in information sharing sessions, provide deposition and / or testimony on case investigations, create internal / external summary reporting, and make suggestions in reaching closure and resolution.

What You’ll Do

  • Receives, logs, and thoroughly documents all incoming complaints, incidents and leads.
  • Performs analyses to detect aberrancies/outliers in claims, policy, and other data in order to proactively seek out and develop leads.
  • Works closely with Adjusters to develop and provide valuable information to assist in the investigative process.
  • Provides case updates on progress of investigations and coordinates with team members/management on recommendations and further actions and/or resolution.
  • Develops and prepares internal Fraud Alerts for company-wide distribution.
  • Works cooperatively with other departments including, but not limited to, Underwriting, Accounting, Legal, and Sales/Marketing.
  • Contacts members, providers, and third parties via telephone interview and/or letter to validate claim submissions.
  • Conducts/assists with on-site audits of claim locations to include claim verification, invoice reconciliation, licensure, and credential verification.
  • Aids in the facilitation of reconciling the claim to include eligibility, benefit, and calculations.
  • Communicates with claims personnel, agents, attorneys, NICB, vendors and other insurance companies, via phone or in writing in a professional and service oriented manner.
  • Prepares summary and/or detailed reports on investigative findings for referral to adjusters, management and attorneys.
  • Coordinates audits of claims, coverages, payments and data, including probe and full statistical samples utilizing either random or targeted methodologies; then extrapolates results to universe.
  • Responsible for meeting all regulatory and departmental deadlines.
  • Provides annual or department specific training to employees and delegated entities, as required.

What You’ll Need to be a Top Candidate

EducationBachelor’s Degree preferred in Insurance, Criminal Justice, Business or a related field.

 

ExperienceThree (3) to Five (5) years’ experience as an SIU adjuster with a carrier required.  Florida personal lines experience preferred.

 

Skills & Knowledge:

  • Ability to analyze facts and coverages in order to evaluate damages.
  • Proven ability in negotiation and investigation required.
  • Ability to communicate interpersonally with individuals and groups via telephone and in writing.
  • Ability to communicate effectively with a wide variety of technical / professional / consumer clients.
  • Microsoft Windows and Office Suite.
  • Familiarity with industry claims systems and property estimating systems such as Xactimate.

Your Environment

Working Conditions: Normal business office environment.  Must be able to remain in a stationary position for periods of time while constantly operating a computer and or other office productivity machinery such as a calculator or telephone.  The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery or communicate with coworkers.  The employee must occasionally lift and / or move up to 10 pounds.

 

Travel: Field travel throughout the state as required.  Must have valid driver’s license.

 

ADA: The above statements cover what are generally believed to be the principal and essential functions of this job.  Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of job duties.  

 

American Integrity Insurance Group is an Equal Opportunity Employer

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