Florida Licensed SIU Investigator

Job Summary

To support fraud detection efforts, the full-time Florida Licensed SIU Investigator will conduct field and desk investigations on high complexity claims, focusing on staged auto accidents and questionable medical treatments while working remotely from the Orlando area.

Key responsibilities:

• Conduct in-depth investigations and examinations under oath to gather evidence on suspected fraud cases
• Prepare comprehensive investigative reports and maintain assigned investigation files
• Collaborate with internal and external stakeholders, including law enforcement and medical professionals, to enhance investigation processes

Required qualifications:

• Associate or bachelor's degree in a related field preferred, along with 5 years of relevant work experience
• Bilingual in English and Spanish
• In-depth knowledge of fraud statutes, regulations, and industry best practices
• Expertise in medical claims processing and familiarity with CPT codes and medical terminology
• Strong analytical and critical thinking skills with proficiency in data interpretation