Special Investigations Unit Life and Health Investigator I
San Antonio, TX
Purpose of Job
Reviews, analyzes and investigates all life, health and waiver of life insurance premium claims to ensure claim validity and legal liability/risk management. Provides recommendations on claim settlements and assists with fraud detection and deterrence. Consults with Legal and Life Underwriting teams and external medical providers as appropriate. Monitors appropriate loss and expense claims reserves.
- Applies proficient knowledge of life, health and disability insurance policy contracts and coverage to ensure appropriate settlement.
- Proactively manages the life of the investigative case, and acts as the liaison between member and internal legal counsel.
- Prepares material for cases and adjusts investigative strategies as required, based on case development.
- Evaluates and negotiates settlement of Income Replacement Disability claims and Competing claims.
- Validates Waiver of Premium, Military Severe Injury, Foreign and Accidental Death claims.
- Gathers supporting documentation to make claim settlement determinations and negotiate claim payments.
- Represents USAA at mediations, case conferences and/or trial as required.
Minimum Education/Experience requirements:
- High School Diploma or General Equivalency Diploma
- 2+ years insurance claims experience
- Proficient knowledge of life insurance industry products, services and claims processes and related medical terminology
- Proficient knowledge of regulations governing life and health claim fraudulent activity
- Knowledge of Microsoft Office products
*Qualifications may warrant placement in a different job level*
When you apply for this position, you will be required to answer some initial questions. This will take approximately 5 minutes. Once you begin the questions you will not be able to finish them at a later time and you will not be able to change your responses.
- 2+ years fraud investigation experience
- 1+ years SIU experience
- Bachelor’s Degree
- 1 – 2 years related experience and accountability for complex tasks and/or projects
Relocation assistance is not available for this position.
The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
Must complete 12 months in current position (from date of hire or date of placement), or must have manager’s approval prior to posting.
Last day to apply to the opening is 7/8/18 by 11:59 pm CST time.