Job Details

Sr. Special Investigative Unit Investigator Field

Company name
USAA

Location
San Antonio, TX, United States

Employment Type
Full-Time

Industry
Insurance

Posted on
Nov 21, 2022

Valid Through
Mar 06, 2023

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Profile

Purpose of Job

Let’s do something that really matters.

At USAA, we have an important mission: facilitating the financial security of millions of U.S. military members and their families. Not all of our employees served in our nation’s military, but we all share in the mission to give back to those who did. We’re over 37,000 strong, working as one to create a great experience and make a real impact for our members.

We believe in our core values of honesty, integrity, loyalty and service. They’re what guides everything we do – from how we treat our members to how we treat each other. Come be a part of what makes us so special!

Job Requirements

We have a remote based position for a Senior Special Investigations Unit Investigator. You will work within defined guidelines and framework, protect USAA and our members from potential fraudulent claims by investigating complex fraud investigations with significant financial impact to USAA which may involve Legal Counsel, government agencies and outside consultants in compliance with state laws and regulations for an assigned operational specialty team

Primary Responsibilities:

Identifies and handles existing and emerging risks that stem from business activities and the job role.

Ensures risks associated with business activities are optimally identified, measured, monitored, and controlled.

Follows written risk and compliance policies, standards, and procedures for business activities.

Leads the execution of fraud prevention strategies and investigative operations.

Leads high exposure, high profile and sensitive work assignments, and special investigations involving complex specialized fraud referrals, (examples: organized provider rings, staged accidents, large losses of significant exposure and broad scale PIP/Casualty Schemes) across multiple entities or functions.

Applies sophisticated knowledge of P&C insurance industry products, services, and processes in investigating claims. This includes P&C insurance policy contracts and coverages and claims handling process and procedures.

Applies sophisticated knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.

Processes large quantities of unstructured detailed information with high levels of accuracy by collecting evidence of potential fraud through field or remote interviews and detailed searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.

Makes appropriate and timely decisions to identify potential complex fraud within defined guidelines.

Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results and outcome of the investigation.

Serves as subject matter authority for team members including providing expert guidance and training for fraud investigations.

Establishes and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.

Develops proactive actions and conveys compelling arguments to influence disposition of arbitrated and litigated cases effectively and efficiently.

Handles CAT duty responsibilities as business requires.

Minimum Requirements:

High School Diploma or General Equivalency Diploma

4 years of P&C SIU/Fraud investigation experience; OR 6 years relevant fraud industry investigation experience.

Experienced knowledge and understanding of fraud investigations as well as application of case law and state laws and regulations.

Must have or obtain a P&C adjusters license within 90 days.

Must be a results-oriented, skilled investigator with experience taking complex statements from multiple parties to an event.

Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.

Proven ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems.

Experience using computers and various software packages to enter and extract data for analysis from relevant data sources and systems.

Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.

Experience in concurrent handling of specialty/complex/litigated claims/cases as well as mediation/arbitration/trial preparation and participation.

Preferred Requirements:

5 years claims handling experience primarily handling 1st and 3rd party medical claims within Property & Casualty.

5 years SIU experience handling major case investigations involving 1st and 3rd party medical claims in a Major Case Unit.

Solid understanding of analyzing CPT codes and medical billing/reports.

Proficient ability to analyze large amounts of data and produce new case leads.

Extensive experience in quality major case report writing and case management.

Recent experience communicating major case investigations to law enforcement and major case investigations in civil litigation.

Recent experience testifying in legal proceedings.

Demonstrated ability of working remotely with limited direct supervision.

Experience conducting field work independently. Field work, including overnight travel may be required.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market position. The hiring range for this position is: $72,900 - $131,400 USD Annually .

Employees may be eligible for pay incentives based on overall corporate and individual performance or at the discretion of the USAA Board of Directors.

Shift premium: Addressed on an individual basis for applicable roles that are consistently scheduled for non-core hours.

Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

To see details on our outstanding benefits, visit USAA Total Rewards. (https://hrportal.ehr.com/usaa/Prospective-Employees)

Relocation assistance is not available for this position.

USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

If you are an existing USAA employee, please use the internal career site in OneSource to apply.

Please do not type your first and last name in all caps.

Find your purpose. Join our mission.

USAA is unlike any other financial services organization. The mission of the association is to facilitate the financial security of its members, associates and their families through provision of a full range of highly competitive financial products and services; in so doing, USAA seeks to be the provider of choice for the military community. We do this by upholding the highest standards and ensuring that our corporate business activities and individual employee conduct reflect good judgment and common sense, and are consistent with our core values of service, loyalty, honesty and integrity.

USAA attributes its long-standing success to its most valuable resource: our 35,000 employees. They are the heart and soul of our member-service culture. When you join us, you'll become part of a thriving community committed to going above for those who have gone beyond: the men and women of the U.S. military, their associates and their families. In order to play a role on our team, you don't have to be connected to the military yourself – you just need to share our passion for serving our more than 13 million members.

USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

Company info

USAA
Website : http://www.usaa.com

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