Job Description

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Multi-state commercial insurance carrier is seeking a Special Investigations Unit (SIU) Triage Analyst to identify, assess, and prioritize suspicious insurance claims or financial transactions to detect fraud, waste, and abuse. They will review referrals from the claims staff, analyze initial loss reports for red flags, assign cases to investigators, and maintain regulatory compliance. Candidates who can work on a hybrid basis out of Dallas, TX are preferred.

Key Accountabilities/Deliverables:

• Case Triaging: Review and analyze incoming referrals to determine if they meet criteria for further investigation, accepting or rejecting them within strict timelines.
• Assignment & Support: Set up new cases in the SIU case management system and assign cases that meet the threshold to investigators while providing necessary background documentation.
• Fraud Detection: Analyze claim data and utilize database tools to identify fraud indicators and suspicious patterns. Conduct data analysis and utilize analytical tools to identify suspicious claims.
• Vendor Management: Submit investigative assignments to vendors to include surveillance and manage those assignments accordingly. Review vendor reports to identify red flags and/or fraud indicators that might warrant further investigation by the SIU.

Technical Knowledge and Understanding:

• Basic proficiency in Microsoft Office including Word, Excel, Outlook
• Understanding various lines of insurance, state insurance regulations, legal concepts and medical terminology.
• Detailed oriented with the ability to work in a team environment and be flexible to daily changing needs and job duties.
• Ability to analyze and solve problems, working closely with others to coordinate and complete projects.
• Excellent oral, written, and interpersonal communication skills.
• Must be customer service oriented, highly organized, and efficient.
• Proficiency with MS Office (Excel) and experience using multiple investigative databases to include but not limited to: TLO, ISO, Accurint, etc.
• Industry related professional designations such as FCLS, FCLA, and/or CIFI preferred.

Experience:

• A bachelor’s degree in criminal justice, Finance, or a related field is preferred.
• This role requires 2–4+ years of claims/investigative experience with an ability to recognize red flags and fraud indicators across multiple lines of insurance.

Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over work authorization sponsorship now or in the future for this position.

#LI-Hybrid

#LI-Remote

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At Core Specialty, you will receive a competitive salary and opportunities for professional development and advancement. We offer medical, dental, vision, and life insurances; short and long-term disability; a Company-match of 100% of a 6% contribution 401(k) plan; an Employee Assistance Plan; Health Savings Account, Flexible Spending Account, Health Reimbursement Account, and a wellness program