SIU Investigative Analyst
Offer summary
Qualifications:
Bachelor's degree in criminal justice, business, insurance, or a related field or equivalent experience., Experience in claims processes, investigation, fraud detection, or a related field is desired., Strong analytical, research, and problem-solving skills., Knowledge of fraud schemes and regulatory requirements (e.g., NICB, SIU compliance) is strongly preferred..Key responsibilities:
- Review insurance claims and documentation for potential fraud indicators.
- Conduct detailed investigations using data analysis, statements, and collaboration with field investigators.
- Prepare reports and referrals to management, law enforcement, and regulatory bodies.
- Coordinate with internal departments and external entities to support fraud detection and resolution.
Job description
The salary range for this job posting is $61,742.00 - $98,788.00 annually + bonus + benefits. Pay Type: Salary
The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process.
Encova Insurance is seeking an SIU Investigative Analyst. This role will be home-based and we have a strong preference for you to reside in Ohio; however, we are open to hiring a well qualified candidate in any state where we can hire as seen in this posting.
Are you a Referral?
If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team.
Unique residence requirements are listed in each job posting, please review closely for details.
Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes:
Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin.
JOB OBJECTIVE:
The SIU Investigative Analyst is responsible for identifying, analyzing, and investigating potentially fraudulent insurance claims or suspicious activities across various lines of business. This role investigates potentially fraudulent insurance claims by triaging SIU referrals, conducting research (including OSINT and social media), occasional recorded statements, and collaborating with investigators, claims professionals, legal and law enforcement. This role ensures regulatory compliance and supports effective fraud resolution. Strong analytical skills and fraud detection expertise are essential.
ESSENTIAL FUNCTIONS:
- Review insurance claims, applications and other documentation for potential fraud indicators or misrepresentation using internal and external systems and databases.
- Identify emerging fraud trends and contribute to the development of predictive analytics or fraud detection strategies.
- Review referred SIU claims and identify the scope of investigation needed.
- Conduct detailed investigations by analyzing data, obtaining statements, and working with field investigators. This role is primarily desk based with limited travel or fieldwork. Investigations requiring fieldwork should be assigned to a field SIU Investigator.
- Assist SIU investigators in compiling case documentation and evidence.
- Compile and document case files with findings, evidence, and recommendations.
- Prepare reports and referrals to management, law enforcement, regulatory bodies, or state fraud bureaus, as required.
- Monitor industry alerts and trends related to fraud schemes and tactics including relevant laws, regulations, and procedures governing insurance fraud.
- Coordinate with internal departments (e.g., Claims, Legal, Compliance) and external entities as necessary.
- Maintain detailed case records and ensure all information is logged accurately.
OTHER FUNCTIONS:
- Complete various special projects and investigations as assigned.
- Network with industry personnel, law enforcement, legal counsel and others to develop information for investigative analysis and leads.
- Act as a subject matter resource providing fraud awareness, investigative consultation and mentorship to company associates.
- Perform other duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
- Bachelor's degree in criminal justice, business, insurance, or a related field or equivalent experience is preferred.
- Experience in claims processes, investigation, fraud detection, or a related field is desired.
- Strong analytical, research, and problem-solving skills.
- Knowledge of fraud schemes and regulatory requirements (e.g., NICB, SIU compliance) is strongly preferred.
- Proficiency with investigative tools, databases, and reporting systems.
- Excellent written and verbal communication skills.
- Multi-line insurance background is a plus.
- Continuing insurance education is desired and may be obtained through designation training offered by industrial organizations such as IASIU.
This position has been evaluated in accordance with the Americans with Disabilities Act. Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons.
Ready to join our team?
At Encova Insurance, we firmly believe that our associates drive our company’s success by delivering unrivaled service to our customers. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating and financially rewarding opportunities.
Join us to discover a work experience where your diverse ideas will be met with enthusiasm – where you can learn and grow to your fullest potential.
What you can expect from us
Join our family of industry leaders, and let us reward you with a competitive salary, bonus and benefits package that includes but is not limited to: a 401(k), wellness programs, bonus incentive plans and flexible schedules, with an early close of the office every Friday. Additionally, Encova aspires to be an outstanding corporate citizen in all the markets we serve; we encourage and support associate participation in community initiatives through our foundations.
Encova Insurance is an EOE/E-Verify employer.
Required profile
Experience
Other Skills
- Problem Solving
- Analytical Skills
- Communication
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