Investigation

Special Investigations Unit (SIU)

A Special Investigations Unit (SIU) is a dedicated department within an insurance company responsible for detecting, investigating, and resolving suspected fraudulent claims. SIU teams combine trained investigators, forensic analysts, and data tools to protect carriers from fraud losses.

In this article

What does an SIU do?How SIU teams are structured The SIU capacity problem Key points How Hesper AI helps FAQ

What does an SIU do?

An SIU investigates claims that have been flagged as suspicious by adjusters, detection software, or anonymous tips. This includes gathering evidence, interviewing claimants and witnesses, analyzing documents for authenticity, reconstructing event timelines, and building case files for denial or legal referral. Most SIUs handle property & casualty, auto, workers' compensation, and liability claims.

How SIU teams are structured

A typical mid-market carrier has 3-8 SIU investigators handling 200+ active cases each. The unit reports to the VP of Claims or Chief Claims Officer. Investigators are often former law enforcement or claims adjusters with fraud certification (CFE, CIFI). The team works with external vendors for surveillance, document forensics, and database searches like NICB and ISO ClaimSearch.

The SIU capacity problem

The core challenge facing SIU teams is volume. About 10% of all P&C claims involve fraud, but most carriers can only investigate 25-30% of flagged claims. The rest expire uninvestigated. Manual investigation takes 14+ days per case, and hiring investigators is expensive - averaging $85-110K per year plus tools and training. This capacity gap costs the industry billions annually.

Key points

SIU teams investigate claims flagged as potentially fraudulent
Average SIU investigator handles 200+ cases simultaneously
Only 25-30% of flagged claims are fully investigated due to capacity constraints
Investigators are typically former law enforcement with fraud certifications
SIU reports to VP Claims or Chief Claims Officer

How Hesper AI helps

Hesper AI acts as an AI-powered extension of your SIU team. Each flagged claim gets an AI investigation agent that handles evidence gathering, statement analysis, and report generation - allowing your investigators to focus on high-complexity cases while every flagged claim gets investigated.

Related glossary terms

Claims Triage Insurance Fraud Red Flags Examination Under Oath (EUO)Document Forensics

Frequently asked questions

Most SIU investigators have backgrounds in law enforcement, military intelligence, or claims adjusting. Common certifications include Certified Fraud Examiner (CFE), Certified Insurance Fraud Investigator (CIFI), and state-specific investigation licenses. Many states also require SIU programs to be registered with the Department of Insurance.

A single SIU investigator at a mid-market carrier typically manages 200+ active cases at any given time. This means each case gets limited attention - often just a few hours over several weeks. The industry average for a full manual investigation is 14+ days per claim.

Many states require insurance companies to maintain an SIU or anti-fraud program. Requirements vary by state - some mandate dedicated staff, others accept outsourced investigation. Carriers must also file suspicious activity reports with state fraud bureaus when fraud is identified.

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