SIU Triage Analyst

Job description

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...