Reporting directly to the Chief Claims Officer, Vice President of Claims, or Director of Claims, the SIU Manager is responsible for managing all aspects of the special investigation unit at Aspire. The SIU Manager also manages and oversees internal and external vendors that are utilized in the investigation, evaluation and defense of suspected fraudulent claims. Additionally, this position is responsible for managing and controlling costs associated with special investigations. This position is responsible for full compliance of CA SIU Regulations and is responsible for developing and maintaining all SIU procedures, ensuring compliance with industry regulations, and is responsible for all SIU training.
DUTIES AND RESPONSIBILITIES:
- Serve as a resource for the entire company for special investigations and fraud;
- Be responsible for selecting and managing a staff of SIU Specialists. This includes determining the appropriate workload that is in the best interests of the company, performing evaluations and mentoring of your staff, and managing and reviewing all SIU files regularly;
- Serve as a resource for all SIU functions for the company and provide feedback, guidance and handling recommendations for all matters involving suspected fraud and SIU;
- Ensure ongoing adjudication of claims within company standards and industry best practices and regulations;
- Determine, recommend and grant authority for settlement and payment processes for losses and expenses;
- Responsible for overall file handling and work product quality of subordinates;
- Produce grammatically correct and clearly written correspondence including letters, memos, reports and claim file documentation;
- Assist in the operations of the claims department, including making recommendations and implementing organizational structure adequate for achieving the department’s goals and objectives;
- Maintain a documented system of claims policies, systems, procedures and workflows to ensure smooth operations;
- Train all new employees per SIU regulations;
- Responsible for ongoing training of all internal anti-fraud personnel;
- Complete annual SIU Compliance Report;
- Attend SIU training and SIU organization meetings and impart the knowledge learned from those meetings to company personnel;
- Provide feedback to Management on process and system improvement initiatives for the department;
- Report to Management as soon there is an awareness of any issues or concerns which may be detrimental to the department or Company; recommend policies and procedures to Management regarding quality issues that may arise;
- Staff Training-Foster a highly focused training and development environment within your direct reports and also for the claims department;
- Comply with state and federal laws, Department of Insurance regulations, insurance carrier best practices and follow and enforce Aspire Claims Service’s and partner’s policies, procedures and work rules;
- Responsible for evaluating, selecting, and ensuring quality and cost containment for vendors including defense firms, private investigators, records review companies, legal document and photocopy companies, expert witnesses and any other vendors that might be used for the settlement of bodily injury claims and lawsuits;
- Communicate and provide timely notification to the Human Resources Department for all things related to employee attendance, punctuality or possible leave related situations;
- Regular and predictable punctuality and attendance;
- Other duties as necessary;
- Evaluate subordinates’ performance and administer personnel actions as required in coordination with human resources department;
- Ability to achieve targeted performance goals;
- Serve as a resource and manager for claims occurring outside of California;
- Interview, and select the best candidates for addition to your staff of SIU specialists;
- Additionally, you will need to determine the appropriate staffing level for your team based upon the Company’s needs;
- Provide appropriate and accurate reports for areas within your job responsibility.
QUALIFICATIONS AND SKILLS:
- 10 plus years experience in Property and Casualty insurance industry.
- 5 plus years as an SIU manger or supervisor. In addition to 5 plus years as an SIU investigator.
- Extensive litigation experience and legal knowledge.
- Must have a clear understanding of insurance industry practices, standards and terminology;
- Extensive experience handling property damage and injury claims as well as serious injuries and litigation.
- Must be able to pass a background check;
- Must have the ability to work in a high volume, fast paced environment while managing multiple priorities;
- Must have a disciplined approach to all job-related activities;
- Must have a solid foundation of personal organization, sound decision making and analytical skills, strong interpersonal and customer service skills;
- Must have strong managerial skills;
- Must have strong keyboard skills as well as proficiency in Windows and MS Office product;
- Work effectively with other managers and supervisors that may or may not report directly to you.
- Must have excellent judgment in decision-making.
- Strong organizational skills.
- Ability to develop excellent working relationships with Staff, Partners, Clients and outside agencies;
- Ability to communicate with others in an effective and friendly manner, one that is conducive to being a conscientious team member, fostering a spirit of good will, indicative of a professional environment and atmosphere;
- Ability to be a team player and work cohesively with other Aspire Claims Service employees and Partner Companies’ staff to achieve company goals;
- Able to represent the Company in a professional manner and contribute to the corporate image;
- Able to consistently provide excellent service.
- This is an exempt position which complies with alternative work schedule when applicable;
- This work environment is fast-paced, and accuracy is essential to successful task completion;
- The office is that of a highly technical company supporting a paperless environment;
- Travel may be required;
- Requires extended periods of computer use and sitting.
- Pay is commensurate with experience”.
*Equal Employment Opportunity Employer