Remote Medical Claims Specialist Jobs in Rio Rancho, NM

Why USAA?

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful.

We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs.

The Opportunity

As a dedicated SIU Investigator, within established guidelines and frameworks, you will investigate suspicious and questionable claims activity, ensuring compliance with all relevant state insurance fraud laws, regulations, policies, and procedures. This role requires a strong understanding of fraud schemes and investigation strategies to effectively analyze claims, gather evidence, and make informed recommendations. You will play a key part in safeguarding USAA's integrity and financial well-being by identifying and mitigating fraudulent activities.

This role is remote eligible in the continental U.S. with occasional business travel.

What you'll do:

• Applies knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third part claims.

• Participates in the development of fraud prevention strategies.

• Applies knowledge of P&C insurance industry products, services, and processes in investigating claims to include P&C insurance policy contracts, coverages and internal claims handling process and procedures.

• Applies knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.

• Collects evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.

• Make recommendations within defined authority guidelines.

• Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results of the investigation and recommended outcome.

• Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.

• May serve as a resource team member on specific matters through demonstrated skill or training.

• Assists with the delivery of fraud awareness training initiatives in a defined environment.

• Handles CAT duty responsibilities as business requires.

• Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and com

What you have:

• High School Diploma or General Equivalency Diploma.

• 2 years claims adjusting experience, or P&C SIU/Fraud Investigation experience OR 4 years prior investigative law enforcement (to include military) or relevant fraud industry investigation experience.

• Proven investigatory skills.

• Experience obtaining statements from various parties to incidents, witnesses, and suspects.

• Ability to gather broad range of evidence and draw conclusions based on objective details related to the applicability of fraud.

• Demonstrated ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems.

• Familiarity with using computers and various software packages to enter and extract data for analysis from relevant data sources and systems.

• Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.

What sets you apart:

• SIU experience conducting low to complex P&C fraud investigations OR a combination of Claims and Law Enforcement Investigations/Military Investigative experience.

• Demonstrated ability to oversee third-party investigative support services, ensuring timely turnaround, accurate reporting, and adherence to company standards.

• Designations such as CFE, CIFI, SCLA, ACLS, FCLS, LPCS, AIC, CPCU, CCLS, or other.

Compensation range: The salary range for this position is: $77,120 - $147,390.

USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).

USAA will consider qualified applicants with a criminal history pursuant to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if USAA is concerned about a conviction(s) that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. Find out more about the Fair Chance Ordinance by visiting the Los Angeles County Office of Labor Standards and Enforcement website.

Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on USAAjobs.com

Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.

USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.