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Director of Special Investigations (Workers Compensation)
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- This individual will serve as a member of our Senior Leadership Team and work collaboratively with fellow Claims, Medical Management, Underwriting, Premium Audit, Finance, and Legal leadership to leverage resources and drive innovative approaches to reduce company losses.
- Collaborates with key Senior Leadership (Claims/Medical Management, Underwriting, Premium Audit, Finance, Legal) to refine and maintain SIU best practices and processes to prevent, detect, investigate and ensure timely reporting of suspected fraudulent activity.
- Creates and facilitates required fraud detection/prevention training to company staff.
- Helps achieve successful investigative outcomes by providing expertise and ensures the internal team and external defense attorneys are providing appropriate legal support to assist in attaining timely and effective outcomes.
- Provides investigative support for Lien Unit and external counsel as requested for litigation addressing issues associated with suspected fraud or abuse of billing and reporting practices.
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