Senior SIU Investigation Adjuster

Accountabilities: Investigate complex and highly complex, multidisciplinary insurance claims referred to the Special Investigation Unit for potential fraud. Conduct comprehensive investigations using background research, online searches, social media research, scene investigations, clinic inspections, witness interviews, and other investigative techniques. Obtain and analyze recorded statements and evaluate information gathered from claimants, witnesses, providers, and other relevant parties. Review and analyze medical records, medical bills, property damage documentation, claim information, and other evidence relevant to the investigation. Follow up on all potential leads and validate that information obtained during an investigation is accurate, complete, and reliable. Use analytical tools, investigative intelligence, and available data to identify suspicious activity and strengthen evidence relating to potential fraud or damages. Determine appropriate claim outcomes based on investigative findings, including whether payment is warranted and whether restitution should be pursued. Review investigations resulting in potential fraud findings to assess whether the available evidence supports claim denial or other appropriate action. Document investigative findings, evaluations, decisions, and supporting evidence clearly and comprehensively within claim systems. Enter and maintain SIU claim information across required investigative and claims-management systems. Update claim files with investigation outcomes and return matters for further handling and settlement when fraud is not established or evidence is insufficient. Manage and resolve complex customer communications, concerns, conflicts, and issues that arise during the investigation process. Conduct research and evaluation of complex online data sources to support investigations and claims decisions. Provide investigative support for matters that may progress to litigation by maintaining accurate, well-documented evidence and investigative records. Requirements 3+ years of investigative experience is preferred. Demonstrated experience investigating insurance claims, fraud matters, or other complex investigative cases. Strong understanding of insurance claims processes, special investigations, and fraud investigation principles. Experience evaluating complex and potentially fraudulent claims using multiple sources of evidence. Strong critical-thinking and analytical skills, with the ability to identify inconsistencies, assess evidence, and reach well-supported conclusions. Excellent research skills, including the ability to conduct online data searches, background investigations, and information verification. Strong interviewing and information-gathering abilities, including experience obtaining statements and conducting witness interviews. Ability to analyze medical documentation, bills, property damage information, claim records, and other relevant evidence. Strong written communication skills and the ability to produce clear, detailed investigative documentation. Excellent organization and time-management skills, with the ability to manage multiple complex investigations and competing priorities. Sound judgment and attention to detail when making claim recommendations and determining whether evidence supports investigative conclusions. Ability to manage sensitive and confidential information professionally. Strong customer-service and conflict-resolution skills when handling complex communications and concerns. Ability to work independently in a remote environment while collaborating effectively with claims, investigation, and other internal teams. Commitment to accurate documentation, consistent investigative processes, and continuous process improvement. Successful completion of any required background investigation. Benefits Annual compensation range of $68,500–$115,600 , based on experience and qualifications. Fully remote work opportunity within the United States. Comprehensive technology setup for remote employees, including a laptop, monitors, headset, keyboard, and mouse. Monthly connectivity reimbursement to help offset internet costs for eligible work-from-home employees. Opportunity to work on complex insurance investigations involving fraud detection, claims analysis, and evidence evaluation. Professional environment that encourages innovation, critical thinking, and continuous improvement. Opportunities to develop and apply specialized expertise in SIU investigations and insurance claims. Supportive environment focused on meaningful work and customer protection. Employment-based visa sponsorship is generally not available for this position.