Description

JOB DESCRIPTION

JOB SUMMARY:
We are seeking a dedicated Investigative Analyst to join our Special Investigations Unit (SIU) Team. The successful candidate will play a key role in supporting the SIU through data entry, research, and regulatory reporting functions. This position serves as the backbone of SIU operations-ensuring that referrals, rescissions, and regulatory submissions are processed accurately and efficiently. The role offers the opportunity to grow into a more advanced analytical and case management capacity, including predictive model review and case assignment responsibilities as experience develops.

RESPONSIBILITIES:
• Referral Intake and Data Entry
o Enter all referrals and related documentation into the SIU database in a timely and accurate manner.
o Ensure data integrity and completeness for each referral record.
• Investigative Support
o Assist SIU Investigators with case development, including conducting LexisNexis, ISO ClaimSearch, and other database inquiries.
o Retrieve and organize background information to support investigations and reporting requirements.
• Rescission Processing
o Prepare and complete rescission requests, ensuring all supporting documentation is accurate, complete, and filed per internal procedures.
• Regulatory Reporting
o Submit required fraud referrals and case updates to State Departments of Insurance (DOI) in compliance with regulatory timelines and formatting standards.
o Utilize data and information from investigator reports to complete DOI submissions.
• Predictive Model Review
o Analyze system-generated alerts from predictive or AI-driven fraud models to identify patterns and potential concerns.
o Collaborate with investigators to refine detection criteria and identify model improvement opportunities.
• Referral Assignment
o Assist with the triage and assignment of referrals to SIU investigators based on workload, expertise, and line of business.
o Monitor case aging and investigator workload to maintain balanced and efficient operations.
• Provide regular updates to senior management on trends and developments
• Projects and duties as assigned


Requisition #: 28488

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