Director, Special Investigations Unit (Remote)
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Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Our Story
Imagine being part of a team thats not just shaping the future but actively driving it. At Davies North America were at the forefront of innovation and excellence blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group we help businesses navigate risk optimize operations and spearhead transformation in the insurance and regulated sectors.
Whats in Store
We are on the lookout for a Director of Special Investigations Unit (SIU) who will be responsible for managing the organizations fraud detection investigation and prevention programs across claims operations. This role oversees investigative strategy regulatory compliance and operational performance of SIU teams to identify investigate and mitigate insurance fraud waste and abuse (FWA).
The Director collaborates with claims leadership legal compliance and external agencies to ensure investigations are conducted effectively while protecting the organization from financial and reputational risk.
Key Responsibilities
SIU Leadership & Strategy
- Develop and execute enterprise SIU strategy to detect investigate and prevent insurance fraud.
- Monitor emerging fraud schemes and industry trends to proactively strengthen detection capabilities.
- Lead and manage SIU investigators SIU 1099s Field Investigators and vendors while establishing performance expectations and KPIs.
- Conduct regular performance reviews of the SIU staff ensuring quality service standards are being met.
Investigations & Fraud Prevention
- Direct investigations into suspected fraud across workers compensation liability property casualty and disability claims.
- Ensure investigations meet company quality standards regulatory standards and evidentiary requirements.
- Review investigation findings reports and approve referrals to law enforcement or regulatory bodies.
- Collaborate with legal teams on litigation support depositions and fraud prosecution efforts.
Regulatory Compliance
- Ensure compliance with state insurance fraud regulations reporting requirements and anti-fraud plans.
- Maintain policies SOPs and training programs aligned with regulatory guidelines and industry standards.
Data Analytics & Risk Detection
- Utilize predictive analytics claims data mining and external fraud databases (e.g. ISO NICB).
- Identify high-risk claims trends and coordinate fraud prevention initiatives with claims leadership.
- Assist leadership as needed with implementing technology and automation to improve investigation efficiency and case outcomes.
Stakeholder & External Partnerships
- Partner with claims underwriting legal compliance and audit teams to identify fraud indicators.
- Maintain relationships with law enforcement regulatory bodies and industry fraud networks as needed.
- Represent the organization in fraud task forces industry groups and regulatory meetings as needed.
This is a full-time remote position.
Skills knowledge & expertise
- 812 years of insurance claims or fraud investigation experience.
- 5 years leadership experience managing SIU or fraud investigation teams.
- Bachelors degree in Criminal Justice Insurance Risk Management or related field preferred.
- Knowledge of insurance fraud statutes and regulatory compliance requirements.
- Experience leading complex fraud investigations and litigation support.
- Certified Fraud Examiner (CFE) preferred.
- Certified Insurance Fraud Investigator (CIFI) preferred.
- Prior law enforcement or investigative background preferred.
- Experience in workers compensation casualty or liability investigations preferred.
Equal Employment Opportunity & Legal Notices
Benefits
At Davies North America we are dedicated to supporting the wellbeing and future of our qualifying employees. Our comprehensive benefits package includes:
- Medical dental and vision plans to support your health and that of your family
- A 401(k) plan with employer matching
- Timeoff policies including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for nonexempt employees
- Paid holidays
- Life insurance and shortterm and longterm disability coverage
Benefit offerings eligibility and required employer contributions may vary based on role classification and applicable federal state and local laws including those tied to an employees primary work location.
Where required by law the Company provides paid sick leave paid family and parental leave and other mandated benefits in accordance with applicable state and local requirements.
Diversity and Inclusion
Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity and we actively promote an environment where all voices are valued and heard.
Compensation Transparency:
The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills experience qualifications and geographic location which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices.
Background Check & Fair Chance Compliance
Compensation Transparency:
The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills experience qualifications and geographic location which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices.
Background Check & Fair Chance Compliance
Any background check or review of criminal history if applicable to the role will be conducted only after a conditional offer of employment and in compliance with applicable federal state and local laws including fairchance hiring requirements.
Massachusetts Notice
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Massachusetts Notice
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Required Experience:
Director
