Senior SIU Claim Representative – Major Casualty Cases

About the role

MAPFRE is seeking an experienced Senior SIU Claim Representative to lead investigations of high‑severity personal injury and casualty claims in Massachusetts. The role focuses on complex, potentially fraudulent cases that involve significant financial exposure.

Key responsibilities

• Investigate and resolve complex casualty claims, including Bodily Injury, PIP/No‑Fault, Med Pay, UM/UIM, and suspected fraud.
• Conduct detailed investigations using recorded statements, scene reviews, witness interviews, and database research.
• Analyze policy coverage, liability exposure, medical records, treatment plans, and billing details.
• Collaborate with field investigators, legal teams, and external partners to gather evidence and build cases.
• Prepare comprehensive reports and recommendations for claim resolution.

Required profile

• Several years of experience as a SIU or major‑case adjuster handling personal injury and casualty claims.
• Deep knowledge of Massachusetts insurance regulations, Code of MA Regulations (CMRs), PIP benefits, and related statutes.
• Proven ability to manage a diverse caseload and make strategic decisions under pressure.

Required skills

• CPT coding analysis
• AIS bill review systems

What we offer

• Compensation commensurate with experience.
• Hybrid or remote work flexibility.
• Opportunity to work independently while collaborating with legal and investigative partners.