Claims Special Investigation Unit Analyst
Pie Insurance is an insurtech company tackling meaningful problems. At Pie, we work with small businesses using technology and innovation to improve how they access insurance. Like our small business clients, we are a diverse team of builders, dreamers, and entrepreneurs. So, at the heart of every decision we make is the idea that if it doesn’t serve our clients, it doesn’t serve us.
The Special Investigation Unit (SIU) Investigator is responsible for the day-to-day oversight of SIU functions within the Claims organization in compliance with contractual and regulatory requirements. The successful candidate will partner with their leader and other stakeholders across the organization on mitigations and remediation activities in support of fraud operation activities to alleviate any potential negative impact to our customers and/or the organization for the Workers' Compensation and Commercial Auto lines of business. This role reports directly to the Claims Special Investigations Unit Manager.
How You’ll Do It
Cross-functional collaboration and communication
- Conducts comprehensive analysis of data and files being worked by the Claims team and the Underwriting team as needed to prevent payment of fraudulent claims.
- Supports the development and communication of SIU programs, practices, and policies.
- Promotes a growth culture within Pie that emphasizes anti-fraud alertness.
- Facilitate live training and discussions related to SIU initiatives as needed.
- Partner with Claims and Underwriting organization's leadership to extract themes and needs.
- Collaborate with other departments, including but not limited to Compliance and L&D teams for cross-departmental projects as required.
Execute all SIU processes, systems, and reporting
- Day to day handling of Special Investigations Unit activities and investigations as well as the technologies and tools required to develop, manage, and deliver SIU processes and reporting .
- Conduct field work as needed.
- Verify and maintain accuracy of data.
- Completes interviews with internal and external parties.
- Prepares cases for criminal prosecution and presents evidence to appropriate law enforcement agencies for prosecution.
- Performs thorough analysis of evidence; assesses veracity of information compiled, to include documentary materials and results of interviews, to develop investigative conclusions.
- Update and maintain materials and tools (i.e. process documents, decks, pdfs, eLearnings, and reference materials) to reflect feedback and company changes.
- Ensure we are partnering with the Claims Regulatory Reporting Specialist and Compliance to accurately report investigations to regulatory agencies.
Execution of Claims and Underwriting SIU practices and strategy
- Collaborate with Claims and Underwriting senior leaders to create and maintain SIU best practices and processes to prevent, detect, investigate and report fraud to appropriate regulatory agencies for all of Pie staff.
- Partner with the Claims Compliance and Underwriting team to ensure unified SIU strategy across various departments.
- Follows written risk and compliance policies, standards, and procedures for business activities.
- Identifies appropriate issues for escalation such as fraudulent trends, vulnerabilities causing increased fraudulent activity and/or larger than normal losses.
The Right Stuff
- High school diploma or equivalent required. Bachelor’s degree in Criminal Justice or Business preferred.
- The person hired for this position will be expected to comply with each state's PI licensing requirement including contract with a vendor if needed.
- 2 years of demonstrated experience working in both Workers’ Compensation and Commercial Auto.
- Advanced communication (written, verbal and presentation) skills, to deliver complex information effectively and align people with the needs of the project/team.
- Advanced problem solving skills, to be able to manage complex situations with multiple layers, and resolve to solution anticipating needs now and into the future.
- Advanced: Advanced awareness of your own and your team's tasks, and how it impacts the organization and deliverables.
- Beginner leadership skills with experience leading large or technical teams through complex deliverables.
- G-Suite Tools, Intermediate excel skills, demonstrated experience working with collaboration tools (Slack is preferred).
Compensation & Benefits
- Competitive cash compensation
- A piece of the pie (in the form of equity)
- Comprehensive health plans
- Generous PTO
- Future focused 401k match
- Generous parental and caregiver leave
- Our core values are more than just a poster on the wall; they’re tangibly reflected in our work
Our goal is to make all aspects of working with us as easy as pie. That includes our offer process. When we’ve identified a talented individual who we’d like to be a Pie-oneer , we work hard to present an equitable and fair offer. We look at the candidate’s knowledge, skills, and experience, along with their compensation expectations and align that with our company equity processes to determine our offer ranges.
Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members.
Unless otherwise specified, this role has the option to be hybrid or remote. Hybrid work locations provide team members with the flexibility of working partially from our Denver or DC office and from home. Remote team members must live and work in the United States* (*territories excluded), and have access to reliable, high-speed internet.
Pie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic.