Life Special Investigations Unit Investigator I (Mid-Level) – Medicare Supplement Fraud Waste & Abuse (Hiring Immediately)
USAA
Phoenix, AZ
1 month ago
$63,590 - $121,530
Job Description
Join USAA as a Mid-Level Life SIU Investigator to analyze and investigate life, health, and annuity claims, ensuring validity and protecting against fraud. You'll play a key role in developing fraud detection programs and supporting the Life Special Investigations team in safeguarding our members.
Key Responsibilities
Conduct moderately complex investigations for potential claims fraud
Gather evidence through various resources to support conclusions
Apply knowledge of laws and regulations to ensure compliance during investigations
Manage the life of an investigation and act as a liaison between parties
Submit fraud reports in compliance with regulatory guidelines
Make claim settlement determinations based on investigations
Represent USAA at mediations and trials as required
Identify and control risks associated with business activities
Required Qualifications
High School Diploma or General Equivalency Diploma
2 years of life insurance claims and/or investigation experience
Proficient knowledge of life insurance products, claims, and underwriting
Proficient knowledge and understanding of fraud investigations and applicable laws
Strong oral and written communication skills
Experience analyzing and interpreting data to identify trends and patterns
Preferred Qualifications
US military experience or a military spouse/domestic partner
5 or more years healthcare/insurance claim investigations experience
2 or more years Medicare or Medicare Supplement claims experience
FE, AHFI, CHC, or other relevant industry designations
Associate degree or higher in criminal justice or a related field
Knowledge of claim billing codes, medical terminology, anatomy, and health care delivery systems
Benefits & Perks
Comprehensive medical, dental, and vision plans401(k) and pensionLife insuranceParental benefits and adoption assistancePaid time off program with paid holidays plus 16 paid volunteer hoursVarious wellness programsCareer path planning and continuing education