About this role
Description
SIU Claims Manager, Injury Vertical
As SIU Claims Manager for the Injury Vertical , you lead about 45 Special Investigation Unit (SIU) investigators and team managers across multiple offices. Together, you decide how we spot, investigate and resolve questionable casualty, medical and small commercial workers compensation claims.
Join the USRM SIU leadership team and shape fraud mitigation strategy for injury lines of business across personal and small commercial lines. This role reports to the Vice President and the SIU Senior Field Manager in USRM Claims & Service.
**Please note: due to end-of-year FTO and the upcoming holidays, hiring timelines may move slower than usual during this period. We appreciate your patience and ask that you expect some delay in hearing back**
What you'll do
- Lead the Injury Vertical and guide SIU Claims Team Managers as they own referrals and resolve questionable claims across regions and segments.
- Direct and coordinate daily work so fraud mitigation, expense, customer service and employee goals stay on track.
- Partner with the SIU Senior Field Manager to develop, implement and execute the fraud mitigation plan for injury lines of business.
- Keep claims compliant and make sure your teams follow company procedures.
- Collaborate with GRS SIU, the USRM Fraud Hub, Legal and other partners.
Ideal Experience Includes:
- Claims adjusting experience in USRM and SIU knowledge.
- Candidates based at a USRM Claims & Service hub in Plano, Marlton, Orlando or Chandler are strongly preferred. You'll meet in the office twice a month.
Why This Role:
Our purpose is to help people embrace today and confidently pursue tomorrow. In SIU, that means protecting honest customers and the integrity of the claims they trust us to handle. You’ll lead a team that does this work every day, with a seat at the leadership table.
Qualifications
- Typically acquired through a Bachelor’s degree or equivalent and 7+ years of progressively responsible work experience in claims, investigations, or related fields, including management experience leading teams (e.g., 25+ people).
- Advanced knowledge of SIU investigations and fraud-fighting strategies, including methods for sourcing referrals (manual processes, AI/predictive models, exception reporting), investigative technology, coverage evaluation, loss assessment, reserving, and claims processes and systems.
- Familiarity with the insurance legal and regulatory environment, medical terminology, and financial concepts relevant to claims.
- Demonstrated ability to set direction, create alignment across business partners, and achieve superior claims outcomes.
- Strong skills in planning and organizing, verbal and written communication, presentations, collaboration, diplomacy/tact, and business/financial acumen.
- Ability to maintain composure, adapt to changing priorities, and drive continuous improvement.
- Experience managing SIU operations across multiple locations or business lines.
- Prior experience implementing fraud detection technologies, vendor management for investigations, or leading cross-functional transformation projects.
Work environment and expectations
- This role involves leading distributed teams and collaborating with multiple business partners, travel may be required based on organizational needs.
- The role requires a commitment to quality outcomes, accountability, and the development of investigative excellence
## Travel
25%