SIU Contract Services

SPECIALIZED INVESTIGATIONS was established in 1981 as a Special Investigation Unit (SIU) of a well established independent adjusting firm that has provided services to many insurance carriers since 1975. Our clients include large and small insurance companies, defense law firms, third party administrators (TPAs), and self-insurers (list of references available upon request).

SPECIALIZED INVESTIGATIONS CONTRACT SIU STAFF OFFERS:

1) Over 30 years in business conducting SIU investigations;

2) Over 15 years’ experience providing SIU management & compliance services, beginning with our flagship company, Fraud Investigation Management & Training (FIMAT);

3) Expertise in providing SIU services for all lines of insurance;

4) Extensive record of SIU referrals resulting in criminal fraud convictions, resulting from strong relationships with law enforcement, NICB, state fraud bureaus, and local prosecutors;

5) Extensive list of SIU training program modules, with SIU training provided to thousands of claims personnel over the past 20 years;

6) Vice President is an SIU/insurance fraud expert, with over 32 years’ experience, is a Certified Fraud Examiner (CFE) and Certified Fraud Specialist (CFS);

7) SIU program consulting expert and former nationwide insurance company SIU Manager on staff;

8) Competitive rates on a “pay as needed” basis, with ability to track and report cost savings;

9) Vendor Management program to oversee and provide quality control of SIU vendors on client’s panel, or assist in establishing or upgrading a vendor panel.

SPECIALIZED INVESTIGATIONS PROVIDES THE FOLLOWING SIU SERVICES:

  • Anti-Fraud Prevention & Reporting Programs
  • Anti-Fraud Training
  • Customized Anti-Fraud Plans
  • Annual SIU Compliance Reporting
  • Liaison with NICB, Law Enforcement & Governmental Agencies
  • SIU File Reviews | Audits
  • Preparation of Cases for Prosecution & Restitution Actions
  • Assist Client Attorneys in Pursuing Civil Remedies Against Fraud Perpetrators
  • Anti-Fraud Policy & Procedures Manuals

Anti-Fraud Evaluation & Compliance

  • Assume full statutory responsibility for SIU compliance requirements;
  • Preparation of customized anti-fraud plans to meet state compliance requirements;
  • Work with clients on establishing cost effective SIU action plans and budgets;
  • Coordinate efforts with other SIU contracted vendors to insure effectiveness of SIU program;

Anti-Fraud Referrals

  • Review and evaluate all SIU referrals for validity and further action;
  • Oversee all questionable claims investigations from inception to final adjudication;
  • Assign and monitor SIU assignments through an established vendor management program and/or experienced SIU staff investigators;
  • File questionable claims with the appropriate state agencies;
  • Liaison with law enforcement agencies, NICB, state fraud bureaus and/or prosecutors in pursuing criminal convictions;
  • Work with client attorneys in pursuing civil remedies against fraud perpetrators;

Anti-Fraud Training

  • Provide extensive SIU training modules, from basic to advanced fraud training courses;
  • Monitor, oversee, and track SIU training needs to meet the state requirements and company objectives;
  • Attend and support regular Anti-Fraud training of key SIU staff personnel responsible for the contract SIU services, with report to client on training received;

Anti-Fraud Administrative Services

  • Provide experienced SIU investigative management personnel to be designated “Director of SIU,” if needed;
  • Prepare Anti-Fraud Policy and Procedure Manual for distribution to all integral Anti-Fraud personnel, as required by state regulation;
  • Periodic claim file reviews/audits, as requested by client, to identify potential SIU referrals, and recommend further action;
  • Reports provided on any specific statistics and/or trends requested by client;
  • Periodic meetings with client management/staff, as requested, to review and implement ongoing SIU program and objectives.

“Working to Solve and Resolve.”