SIU Claims Adjuster (Non-Standard Auto and Casualty)

Position Summary The SIU Claims Adjuster is responsible for investigating suspected insurance fraud, material misrepresentations, suspicious claim activity, and potentially abusive or inflated losses involving non-standard automobile and casualty insurance policies. This position combines investigative expertise with insurance claims knowledge to identify, investigate, document, and refer potentially fraudulent activity while supporting accurate, fair, timely, and legally compliant claims decisions. The individual will investigate personal auto and casualty claims, including bodily injury, property damage, staged or exaggerated accidents, questionable vehicle thefts, questionable medical treatment, organized fraud activity, and potential application or underwriting misrepresentations. The position works closely with other claims employees, underwriting, legal counsel, management, external investigators, law enforcement, and state insurance fraud authorities. Essential Duties and Responsibilities 1. SIU Investigations and Fraud Detection

• Investigate claims referred to SIU based on suspicious circumstances, inconsistent statements, material discrepancies, unusual loss patterns, or other reasonable indicators of potential fraud.
• Identify and investigate suspected staged accidents, phantom passengers, questionable injury claims, inflated repair estimates, vehicle theft misrepresentations, prior damage, questionable loss dates, and other suspicious activities.
• Review claim histories, policy applications, underwriting records, police reports, photographs, estimates, medical bills, recorded statements, and other relevant documentation.
• Conduct recorded or written interviews with insureds, claimants, witnesses, drivers, passengers, repair facilities, medical providers, and other relevant parties, as authorized.
• Use approved investigative databases, public records, social media, and other lawful investigative resources consistent with company policy and applicable law.
• Coordinate field investigations, scene inspections, vehicle examinations, surveillance, and independent investigative assignments when appropriate.
• Identify potential connections among claimants, vehicles, addresses, telephone numbers, providers, repair shops, attorneys, and other parties when supported by evidence.
• Preserve evidence, maintain accurate investigative timelines, and document all investigative activity.

2. Claims Adjusting and Technical Analysis

• Review coverage, policy terms, endorsements, exclusions, declarations, application information, and relevant underwriting documentation.
• Evaluate liability, damages, causation, injury allegations, prior losses, and inconsistencies between reported facts and available evidence.
• Analyze potential first-party and third-party exposures involving automobile physical damage, property damage, bodily injury, and other assigned casualty claims.
• Identify potential coverage concerns and material misrepresentations and refer coverage determinations to the appropriate claims authority or legal counsel.
• Provide Claims leadership with objective investigative findings, supporting evidence, exposure considerations, and recommendations for appropriate next steps.
• Assist with claim strategy, litigation support, examinations under oath, independent medical examinations, expert reviews, and defense counsel coordination when appropriate and authorized.
• Maintain a clear distinction between indicators of suspected fraud and substantiated findings; do not treat a referral alone as proof of wrongdoing.

3. Regulatory Compliance and Fraud Referrals

• Follow applicable SIU procedures, investigation standards, documentation requirements, and reporting timelines for California, Texas, and Arizona.
• Prepare thorough investigative reports summarizing the referral basis, allegations, evidence obtained, interviews completed, material inconsistencies, investigative findings, and outstanding issues.
• Recommend and prepare suspected fraud referrals to the appropriate state insurance department or other authorized agency in accordance with applicable law and company procedures.
• Maintain complete, accurate, and audit-ready investigative files.
• Support internal compliance reviews, SIU audits, required training, regulatory inquiries, and management reporting.
• Protect confidential information and comply with privacy, consumer protection, fair claims handling, evidence preservation, and records-retention requirements.

4. Collaboration and Case Management

• Partner with auto physical damage, bodily injury, casualty, underwriting, subrogation, litigation, and claims operations teams.
• Communicate findings clearly and promptly to the assigned claim owner, SIU and Claims leadership.
• Manage a prioritized caseload and meet established investigation milestones and documentation standards.
• Recommend opportunities to improve fraud detection, referral quality, investigative procedures, and claims controls.
• Participate in case conferences, fraud trend reviews, training, and special projects as assigned.

Minimum Qualifications

• Three or more years of experience in insurance claims adjusting, SIU investigations, insurance fraud investigation, or a closely related field.
• Demonstrated knowledge of personal automobile insurance, liability investigations, claim documentation, coverage analysis, and claims handling practices.
• Experience evaluating inconsistent statements, questionable damages, suspicious loss circumstances, or potential material misrepresentations.
• Strong interviewing, analytical, research, report-writing, and evidence-documentation skills.
• Ability to manage confidential information and conduct objective, impartial investigations.
• Proficiency with claims management systems, investigative databases, Microsoft Office, and electronic documentation tools.
• Valid driver's license and ability to travel on some limited occasions for field investigations if needed.
• Ability to work across multiple jurisdictions and coordinate with internal and external stakeholders.

Preferred Qualifications

• Five or more years of progressively responsible claims or SIU experience.
• Experience in non-standard automobile insurance, high-frequency claims environments, bodily injury, or casualty claims.
• Multi-state claims handling or SIU experience in California, Texas, and Arizona.
• Familiarity with state insurance fraud referral processes and SIU compliance requirements.
• Relevant professional designations, such as the Certified Insurance Fraud Investigator (CIFI), Associate in Claims (AIC), or comparable credentials.
• Experience with staged accident investigations, organized fraud indicators, medical-provider billing patterns, vehicle theft investigations, or litigation support.

Core Competencies

• Investigative judgment and critical thinking
• Claims evaluation and coverage analysis
• Fraud pattern recognition
• Interviewing and evidence development
• Clear, defensible investigative reporting
• Regulatory awareness and ethical decision-making
• Time management and caseload prioritization
• Effective communication and cross-functional collaboration

Performance Expectations Performance will be evaluated using a balanced combination of investigative quality, operational efficiency, regulatory compliance, and claims outcomes, including:

• Timely completion of investigations and documented case milestones.
• Quality, accuracy, and completeness of investigative reports.
• Quality of evidence supporting investigative conclusions and recommendations.
• Appropriate identification and referral of suspected fraud.
• Compliance with applicable reporting requirements and internal procedures.
• Productive collaboration with claims, underwriting, legal, and SIU leadership.
• Demonstrable contribution to appropriate claim outcomes and fraud-loss mitigation.

Investigative referrals, denials, or suspected savings should not be used as standalone performance measures. Employees must not be incentivized to deny legitimate claims or make unsupported fraud allegations. Working Conditions This position may involve a combination of remote or office-based file investigation, telephone interviews, field investigations, travel, and occasional work outside standard business hours. Travel throughout California, Texas, and Arizona may be required depending on claim assignments and territory coverage. Equal Employment Opportunity The company is an equal opportunity employer and considers qualified applicants without unlawful discrimination. Reasonable accommodations are available to qualified individuals in accordance with applicable law. Pay: $75,000.00 - $100,000.00 per year Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):

• Do you have experience handling multi-state claims of SIU experience in California, Texas and Arizona?
• Do you have familiarity with state insurance fraud referral processes and SIU compliance requirements?

Experience:

• insurance adjusting or insurance fraud investigations: 3 years (Required)

Work Location: Remote