Claims SIU Consultant

Builders Mutual

. Serve as the single point of accountability for fraud identification and handling strategy across Workers’ Compensation, General Liability, Commercial Auto, Builders Risk, Inland Marine, and Property lines .

Posted 10/5/2026full-timeRemote • North Carolina • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Expertise in fraud identification and handling strategy across multiple insurance lines, with a strong focus on developing tracking methodologies and compliance with SIU and antifraud regulations. Proven ability to manage vendor relationships and deliver training to claims adjusters and underwriting staff.

Highest-signal resume keywords

Fraud Investigation ExperienceVendor Relationship ManagementInsurance Fraud Statutes KnowledgeClaims Data ReportingTraining and Consultation Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Fraud IdentificationSIU Program ManagementQuality Assurance Framework DesignReferral Outcome TrackingCost AuditingData AnalysisRegulatory ComplianceFraud-Recognition TrainingClaims Adjuster GuidancePerformance Evaluation

Soft Skills

Strong Communication SkillsSound JudgmentInitiativeIndependent Operation

Industry Keywords

Workers’ CompensationGeneral LiabilityCommercial AutoBuilders RiskInland MarineProperty LinesNAIC Insurance Fraud Prevention Model ActSIU Model RegulationMulti-State ComplianceReferral Patterns

About the role

Key responsibilities & impact

Serve as the single point of accountability for fraud identification and handling strategy across Workers’ Compensation, General Liability, Commercial Auto, Builders Risk, Inland Marine, and Property lines
Set SIU program direction and priorities with Claims leadership
Communicate program performance, trends, and recommendations to senior leadership
Identify cross-line fraud trends, referral patterns, and emerging investigative needs
Own and manage SIU vendor relationships, including referral quality review, invoice and cost auditing, service-level performance tracking, and periodic vendor evaluation
Design and maintain a quality assurance framework for SIU referrals and investigative outcomes
Establish and maintain referral outcome and savings-tracking methodology for quarterly and annual ROI reporting
Build recurring reports on referral volume, cost per referral, outcome type, line-of-business distribution, and other metrics
Consult with Underwriting on front-end, premium, and new-market fraud indicators
Develop and deliver fraud-recognition training for claims adjusters and underwriting staff
Create and maintain adjuster-facing referral guidance, job aids, and procedures
Ensure state-specific SIU and antifraud-plan reporting obligations and mandatory referral procedures are met
Maintain knowledge of SIU/antifraud requirements and support a compliance matrix for the company’s multi-state footprint
Report to the Vice President of Claims

Requirements

What you’ll need

Bachelor's degree preferred
Minimum of five (5) years of relevant claims, SIU, or fraud-investigation experience, or an equivalent combination of education and experience
Law Enforcement experience is a plus
Demonstrated experience managing or governing a vendor relationship of meaningful scope and cost, including invoice auditing and performance evaluation
Working knowledge of insurance fraud statutes and SIU/antifraud regulatory frameworks, including the NAIC Insurance Fraud Prevention Model Act and related SIU Model Regulation
Demonstrated ability to build tracking methodologies and translate claims data into defensible, decision-ready reporting
Strong verbal and written communication skills
Ability to train adjuster staff and consult effectively with Underwriting
Sound judgment, initiative, and ability to operate independently as an individual contributor
Ability to travel 10–15% for vendor site engagement, industry conferences, and state regulatory matters
Ability to travel occasionally for vendor relationships and compliance

Benefits

Comp & perks

Competitive compensation and a performance bonus program
3 weeks of PTO to start, plus your birthday off
A 37.5-hour workweek, with Fridays ending at 2:30 PM
Professional development through Builders University
Everyday Wins recognition with swag and extra time off
8 paid Volunteer Time Off (VTO) hours to give back
Comprehensive benefits that support your wellbeing today and your future tomorrow
Remote work from a home office
Virtual collaboration with the team
Company events and meetings