SIU Analyst

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. 

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

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SIU Analyst

PRIMARY PURPOSE: To review referrals from claim scoring and/or claim monitoring technologies (i.e. ISO Claim Director and SIU JURIS triggers) to determine whether suspicious indicators are present; to identify patterns of questionable claims activity involving personal injury claims, auto property losses, and casualty losses.

ESSENTIAL FUNCTIONS and 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, files claim 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)

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred.
 Experience

Five (5) years of insurance investigation experience or equivalent combination of education and experience required.

Skills & Knowledge

• Good oral and written communication skills

• PC literate, including Microsoft Office products

• Knowledge of insurance claim investigative procedure(s)

• Attention to detail

• Ability to work in a team environment

• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlinesPhysical: Computer keyboarding, travel as requiredAuditory/Visual: Hearing, vision and talking

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $54,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

 

 

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

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