SIU Analyst

$51,000 - $51,000/Yr

Sedgwick

Full-time - Mid Level

Insurance Carriers and Related Activities

About the position

At Sedgwick, we prioritize taking care of our colleagues, fostering a culture of caring that extends to our clients and the communities we serve. A career with us means having the flexibility to balance your personal and professional life while engaging in meaningful work that makes a positive impact. We support our employees' mental, physical, financial, and professional needs, providing opportunities for skill enhancement and career growth. Our work environment is one that celebrates diversity, fairness, and inclusivity, ensuring that everyone feels valued and empowered. If you are passionate about making a difference and enjoy challenges, Sedgwick is the right place for you. As an SIU Analyst, your primary responsibility will be to review referrals from claim scoring and monitoring technologies, such as ISO Claim Director and SIU JURIS triggers, to identify suspicious indicators in claims. You will investigate claims to uncover potential criminal activities, false claims, staged accidents, or unnecessary medical treatments. This role requires a keen analytical mindset to assess claims for fraud indicators through case reviews and other methods. You will collaborate with examiners and clients to develop investigation action plans and identify claims that meet state fraud reporting criteria, filing claims with the appropriate state agencies when necessary. Additionally, you will recommend further investigations or escalate cases to SIU consultants as needed. Your contributions will support the organization's quality programs and ensure that we maintain high standards in our investigative processes.

Responsibilities

• Investigates claims to uncover criminal activity, false claims, staged accidents, or unnecessary medical treatments.
• Analyzes claims for fraud indicators through case review and other analytical methods.
• Reviews referrals from claim scoring and/or claim monitoring technologies to determine if suspicious indicators are present.
• Reviews red flags identified from investigative efforts to verify suspicious indicators.
• Collaborates with examiner/client in the development of the investigation action plan.
• Identifies claims that meet state fraud reporting criteria and files claims with appropriate state agencies.
• Recommends further investigation and/or escalation to SIU consultant.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Requirements

• Bachelor's degree from an accredited college or university preferred.
• Five (5) years of insurance investigation experience or equivalent combination of education and experience required.
• Good oral and written communication skills.
• PC literate, including Microsoft Office products.
• Knowledge of insurance claim investigative procedures.
• Attention to detail.
• Ability to work in a team environment.
• Ability to meet or exceed performance competencies.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• 401k and matching
• Paid Time Off (PTO)
• Disability insurance
• Life insurance
• Employee assistance programs
• Flexible spending or health savings account
• Other additional voluntary benefits