SIU Specialist

Job description

SUMMARY: While the primary focus of the SIU Specialist is the development and management of vendor‑conducted SIU investigations, this position is primarily responsible for managing surveillance and other investigations for California claims while also coordinating investigation‑related processes to service the brand book of business. A high level of knowledge of California laws, regulations, and Department of Insurance (CDI) requirements required to ensure all investigative activity is legally compliant. The position will handle individual and multi‑case investigations while building the SIU capabilities for the brand. This includes the SIU referral process, monitoring external investigation vendors, and providing direction for additional investigation opportunities. This position is responsible for fraud investigations, California‑specific SIU compliance and annual regulatory reporting, anti‑fraud training, and SIU quality assurance. The SIU Specialist examines reports, reviews video, and invoices for accuracy. Additional responsibilities include development, oversight, and implementation of medical provider fraud investigations. The position requires the ability to conduct invest...