Senior Claims SIU Inside Investigator

Senior Claims SIU – Inside Investigator

The Senior Claims SIU Inside Investigator plays a critical role in identifying and investigating potential insurance fraud. This position focuses on desk-based investigations that do not require fieldwork, or where fieldwork can be delegated to SIU field investigators or external vendors.

What You’ll Do:

• Investigate suspected fraud involving clients, third-party claimants, and suppliers (e.g., auto body shops, medical treatment providers) using internal resources and SIU vendors.
• Develop initial investigation strategies and update them as needed throughout the lifecycle of each file.
• Review submitted documents for discrepancies and verify their accuracy.
• Conduct thorough, audio-recorded interviews and obtain statements from clients, witnesses, and other relevant parties.
• Coordinate and participate in examinations under oath when required.
• Identify fraud patterns, assess loss exposure, and recommend mitigation strategies.
• Perform key investigative tasks, such as obtaining official reports and consulting with experts for additional insights.
• Prepare comprehensive final reports and provide recommendations to the claims department regarding file disposition.
• Review and prioritize incoming SIU referrals based on incurred amounts, complexity, visibility, potential risk, and limitation dates.
• Assign cases within designated timeframes to appropriate SIU handlers.
• Assist in the design and delivery of customized fraud awareness, detection, investigation, and prevention training for specialized business lines, including Underwriting, Claims, and Business Development.
• Act as a subject matter expert on insurance fraud for internal teams, clients, and brokers on an ad hoc basis.
• Ensure all investigations are conducted professionally, proactively, and in good faith, with timely responses to customer and broker inquiries.
• Support industry-wide anti-fraud initiatives by attending training sessions, CASIU events, Equite committee meetings, and other relevant forums to stay current on fraud trends.
• Contribute to the review, implementation, and ongoing use of artificial intelligence tools for fraud detection, including validating outputs, tracking savings, and reporting results.

What You’ll Need to Succeed:

• Minimum 3 years of experience in insurance fraud investigations.
• Minimum 3 years of experience in claims handling.
• College or University education.
• CIP, CFEI, or CFE are preferred.  
• Demonstrated expertise in conducting fraud-related investigations.
• Strong knowledge of anti-fraud practices and investigative techniques.
• Excellent analytical skills to identify patterns, quantify exposure, and develop mitigation plans.
• Proficient interviewing and statement-taking abilities.
• Strong written and verbal communication skills for reporting, training, and stakeholder engagement.
• Familiarity with industry events, ongoing training, and AI tools for fraud detection.

Location: Hybrid - We operate under a flexible hybrid work model designed to support collaboration, productivity, and work-life balance. This role is primarily based in Cambridge, Ontario, with an expectation of being on-site two days per week.

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