For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, Sustainability initiatives and inclusive corporate culture.
The SIU team is currently seeking an SIU Specialist. This is a full-time, exempt position with a remote or hybrid work schedule seated in one of our Claims offices. Travel may be required.

POSITION OVERVIEW:

The SIU Specialist is responsible for leading and executing investigations into suspected fraud across medical, major case, and underwriting domains. This role will target Medical claims to ensure compliance with regulatory standards, supports litigation efforts, and collaborates with internal and external stakeholders to mitigate risk and uphold ethical claims practices.

• Supervise, coordinate and monitor activities of medical fraud investigations in order to obtain and ensure an accurate, quality product while maintaining high production and performance standards.
• Evaluate and give guidance to investigators on an ongoing basis.
• Coordinate and act as a liaison with other departments in which SIU interacts.
• Recommend procedural changes, plan, organize and implement the changes under SIU leadership guidance.
• Ensure proper reporting to appropriate state and fraud prevention agencies in accordance with company policy and regulatory requirements.
• Research and analysis of complex medical investigations involving claims for all lines of business.
• Provide continuing education on SIU initiatives to other departments.
• Position to target assignments generated from fraud models: MedSentry, ABI, WC and CGL.
• Additional oversight on NICB alerts, ForeWarns, AMD’s, Strategic Alerts.
• Target states with low penetration rates to drive diversification.
• Leverage/manage field staff for RS, scene work ups, witnesses canvassing, clinic visits.
• Supervise, coordinate and monitor activities of medical fraud investigations conducted by field personnel and management of approved PI vendors.
• Research and analysis of complex medical investigations involving claims for all lines of business in the casualty and specialized response teams.
• Evaluate and give guidance to desk/field investigators.
• Coordinate and act as a liaison with local, state, and federal medical fraud task forces that includes Medicare/Medicaid groups (attends meetings that drive referrals for trends/schemes identified by these task forces).
• Ensure proper reporting to appropriate state and fraud prevention agencies in accordance with company policy, business expectations and regulatory requirements.
• Provide continuing education on SIU initiatives in the medical fraud space to other departments.