• SIU Director

    Job Locations US-PA-Wilkes-Barre
    Job ID
    2018-1735
    # of Openings
    1
    Category
    Claims
  • Overview

    Berkshire Hathaway GUARD Insurance Companies, rated A+ (“Superior”) by the leading independent rating organization for the industry, is growing rapidly and has operations throughout the US. We are seeking a SIU Director that will bring a systemic approach to identifying and addressing fraud and suspicious risks.

    Responsibilities

    In this position, the Director will develop a prospective approach to handling issues and the focus of this department will be to enhance awareness of risk mitigation. The manager will also interact with other disciplines, such as Underwriting and Premium Audit, and develop ways to identify and mitigate suspicious risks and/or fraud. Those responsibilities will include:

     

    • Supervise and coach the Special Investigation Team
    • Establish procedures for the departments to report suspected or potential fraud and controls to ensure that the unit thoroughly investigates all reports of alleged fraud
    • Oversee the preparation of files for possible criminal/civil litigation
    • Manage special projects designed to identify and address fraud that may involve other disciplines within Guard’s organization, for example: examination of high dollar pharmacy claims, provider fraud, undocumented workers and premium fraud
    • Oversee the preparation, completion and submission of annual Anti-Fraud Plan Reports to the Departments of Insurance as mandated by law in those jurisdictions where Guard is licensed to do business

    • Prepare the education and training sessions regarding fraud to Guard employees, including the Annual Claims Meeting
    • Supervise all investigations into alleged workers' compensation fraud
    • Be responsible for reviewing and determining the appropriate course of action with SIU personnel on any suspected fraud referral
    • Coordinate together with SIU personnel, investigations with private investigators and surveillance companies
    • Hire legal counsel as necessary to assist with the investigation and prosecution of fraud
    • Consult and work collaboratively with Guard personnel from other divisions, including but not limited to Underwriting and Premium Audit, regarding fraud, abuse, prevention and investigation
    • Maintain accurate records of files referred for possible fraud/abuse activity as well as records of the outcome of those referrals

     

     

     

    Qualifications

    • 5 years or more experience with SIU/FRAUD investigation; preferably in claims
    • Experience with process management and program development
    • Knowledge of the latest cyber technology resources
    • Management/Supervisory experience

     

     

    About Us:

     

    At Berkshire Hathaway GUARD Insurance Companies, we take great pride in bringing out the best in our employees guiding them along a career track of professional development and success!

     

    Backed by our ultimate parent, Berkshire Hathaway Inc, we are aggressively expanding and enhancing our commercial lines products offerings with the goal of being the premier name for business insurance which creates opportunities for our staff! 

     

    Some Highlights of our Benefits are:

    • Excellent working hours (Operating hours are from 8am-4:30pm M-F).
    • Generous amount of vacation and sick time. Closed on all major holidays.
    • 401K with company match and profit sharing.
    • A competitive healthcare package.
    • Tuition reimbursement after 6 months of employment. 
    • Be part of Berkshire Hathaway, one of world's most admired companies. We offer opportunities to advance your career!

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