Special Investigations Unit Life and Health Investigator I (Mid-Level)

**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. **The Opportunity** + USAA Life Company's SIU Life & Health is seeking a talented **Life Special Investigations Unit Investigator I (Mid-Level)** to review, analyze, and investigate life, health, and annuity claims to ensure claim validity and to protect the association from potentially fraudulent activity. This role will provide investigative support and recommendations on claim settlements and assists with fraud detection and deterrence, as well as, investigate fraud investigations that may have significant financial impact to Life Company and/or the association. Consult and involve Legal Counsel, Underwriting, law enforcement, and other agencies as appropriate.As a Mid-Level Life SIU Investigator for **Medicare Supplement Fraud, Waste, and Abuse** you will support the Life Special Investigations team that is responsible for increasing fraud awareness throughout USAA and its membership, developing innovative fraud detection and prevention programs, and investigating cases of suspected fraud for Life Company.We offer a flexible work environment that requires an individual to be **in the office 4 days per week.** This position can be based in one of the following locations: San Antonio, TX, Phoenix, AZ, Colorado Springs, CO, Tampa, FL, or Plano, TX. Relocation assistance is **not** available for this position. **What you'll do:** + Conducts moderately complex investigations for life, health, and annuity products for potential claims fraud. + Gathers evidence through interviews, searches of investigative databases, internal resources, internet resources, medical records, law enforcement records, and/or public records to support conclusions while adjusting investigative strategies as necessary. + Prepares detailed and comprehensive investigative reports to summarize and substantiate the results/outcome of the investigation. + Applies proficient knowledge of state/federal laws and regulations and legal concepts, including contract and case law, to ensure investigations are conducted within regulatory requirements. + Applies proficient product and system knowledge to ensure appropriate investigation and/or claim settlement. + Proactively manages the life of an investigation and acts as the liaison between the member, legal counsel, law enforcement, and other related agencies, as appropriate. + Submits Department of Insurance fraud reports in compliance with established regulatory guidelines and time frames. + Uses evidence of investigation and supporting documentation to make claim settlement determinations and recommendation for claim payments. + Represents USAA at mediations and/or trial as required. + Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. **What you have:** + High School Diploma or General Equivalency Diploma required. + 2 years of life insurance claims and/or investigation experience. + Proficient knowledge of life insurance products, claims, and underwriting. + Proficient knowledge and understanding of fraud investigations as well as application of state/federal laws and regulations. + Ability to gather a broad range of evidence and draw conclusions based on the objective details. + Strong oral and written communication skills. + Demonstrated experience analyzing and interpreting data to identify trends and patterns **What sets you apart:** + US military experience through military service or a military spouse/domestic partner + 5 or more years Medicare or Medicare Supplement claim processing, operations, or administrative experience. + 5 or more years healthcare fraud, waste, and abuse investigation and/or audit experience. + Advanced knowledge of healthcare benefit structures within the health insurance industry, Medicare or Medicare Supplement preferred. + Proficient knowledge of medical claims coding ICD-10, CPT, HCPC, EDI 837, etc. + CFE, CHC, AHFI, or Certified Professional Coder (CPC) certifications. + 2 or more years of experience in negotiating or settling health insurance claims. + Proficient knowledge of state and federal regulatory requirements for fraud, waste, and abuse. + Demonstrated experience analyzing and interpreting data to identify trends and patterns. **Compensation range:** The salary range for this position is: $63,590 - $121,530 **.** **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.).** **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._ **If you are an existing USAA employee, please use the internal career site in OneSource to apply.** **Please do not type your first and last name in all caps.** **_Find your purpose. Join our mission._** USAA is unlike any other financial services organization. The mission of the association is to facilitate the financial security of its members, associates and their families through provision of a full range of highly competitive financial products and services; in so doing, USAA seeks to be the provider of choice for the military community. We do this by upholding the highest standards and ensuring that our corporate business activities and individual employee conduct reflect good judgment and common sense, and are consistent with our core values of service, loyalty, honesty and integrity. USAA attributes its long-standing success to its most valuable resource: our 35,000 employees. They are the heart and soul of our member-service culture. When you join us, you'll become part of a thriving community committed to going above for those who have gone beyond: the men and women of the U.S. military, their associates and their families. In order to play a role on our team, you don't have to be connected to the military yourself - you just need to share our passion for serving our more than 13 million members. USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law. California applicants, please review our HR CCPA - Notice at Collection ( here. USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.