Senior Claims SIU Inside Investigator

As a Senior Claims SIU Inside Investigator at Gore Mutual, you will take on significant responsibilities, including investigating potential fraud across various claim types, strategizing investigation plans, conducting interviews, analyzing discrepancies in documentation, and composing detailed reports to guide the claims department. You'll also participate in training sessions, support inter-industry anti-fraud initiatives, and leverage AI tools to enhance fraud detection efforts.

To be considered for the Senior Claims SIU Inside Investigator role at Gore Mutual, candidates need a minimum of 3 years of experience in insurance fraud investigations and claims handling. Familiarity with anti-fraud practices, strong analytical skills, proficiency in database maintenance, and excellent communication skills are crucial to effectively succeed in this position.

The Senior Claims SIU Inside Investigator plays a pivotal role in fraud prevention by conducting thorough investigations, identifying patterns of fraud, and developing mitigation plans. This individual also provides training to various teams, ensuring that everyone understands the importance of fraud detection and reporting, thereby fostering a culture of vigilance within the organization.

The Senior Claims SIU Inside Investigator position at Gore Mutual follows a hybrid work structure, which requires you to work in-person at our Cambridge office at least once a week. This allows you to enjoy the benefits of flexibility while fostering collaboration and team dynamics in the workplace.

At Gore Mutual, new Senior Claims SIU Inside Investigators can expect a robust onboarding process complete with training on company protocols and industry standards. You'll also have opportunities for ongoing professional development, including participation in industry training, events, and access to resources that keep you updated on the latest trends in insurance fraud.

When answering this question, be specific about your roles and the types of investigations you have conducted. Highlight your analytical skills and any tools or techniques you used to uncover fraudulent claims, which aligns well with the responsibilities of the Senior Claims SIU Inside Investigator at Gore Mutual.

Discuss your time management skills and demonstrate how you assess incoming referrals based on factors like complexity and potential risk. This is vital for the Senior Claims SIU Inside Investigator position you are applying for.

Explain your investigative process and detail how you communicate findings. Give examples of times you took proactive actions to ensure accuracy that resonate with the job's expectations at Gore Mutual.

Share your methodology for preparing and executing interviews. Explain how establishing rapport helps to obtain accurate statements, which is crucial for the role of Senior Claims SIU Inside Investigator at Gore Mutual.

Discuss any experience you have working with AI tools in investigations. Mention specific tools you've used and how they helped improve detection rates, showing your understanding of emerging technologies relevant to the Senior Claims SIU Inside Investigator role.

Detail a specific case where you faced challenges, highlighting your problem-solving skills and analytical abilities. Focus on how your actions led to a resolution, which showcases your fit for the position.

Explain your commitment to maintaining professionalism and ethics in your investigations. This aligns well with the expectations at Gore Mutual for conducting fair and accurate investigations.

Describe analytical techniques or tools you have used to identify trends in insurance fraud. Being specific will demonstrate your knowledge and suitability for the Senior Claims SIU Inside Investigator role.

Discuss your commitment to ongoing education and attending industry events. Highlight how you plan to integrate learned knowledge into your work, which is aligned with the responsibilities of the position at Gore Mutual.

Emphasize your communication and coordination strategies with vendors. Detailing a specific instance where effective collaboration led to successful investigations can illustrate your expertise for the role.