Enters SIU claim data information into multiple SIU systems
Reviews investigations with fraud outcomes to validate whether denial is appropriate
Updates files with investigation outcome, and when no fraud or insufficient evidence is found, returns file to MCO for further handling and settlement
Conducts complex online data application searches, research, and evaluation
Conducts complex site inspections, including body shops, medical clinics, loss locations etc.
Conducts thorough investigations of complex that are potentially fraudulent to determine if payment is warranted, including scene investigations and surveillance as needed
Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads
Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision-making process
Utilizes analytic tools or SIU field intelligence to identify complex claims for investigation and/or for support in the evidence of the fraud and damages
Researches and responds to complex customer communications, concerns, conflicts or issues
Supervisory Responsibilities
This job does not have supervisory duties.
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Benefits
Base compensation offered for this role is:SIU Investigator Cons I: $60,000 - $98,450SIU Investigator Cons II: $62,100 - $105,300SIU Investigator Sr Cons I: $68,500 - $117,700And is based on experience and qualifications. Total compensation for this role is comprised of several factors, including the base compensation outlined above, plus incentive pay (i.e. commission, bonus, etc.) if applicable for the role.For jobs in San Francisco, please click " here " for information regarding the San Francisco Fair Chance Ordinance.For jobs in Los Angeles, please click " here " for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance.To view the "EEO Know Your Rights" poster click " here ". This poster provides information concerning the laws and procedures for filing complaints of violationHealth insurancePerformance bonus
Additional Information
National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers' evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.
Job Description
This job is responsible for investigating and analyzing complex, multi-discipline coverage and claims that have been referred to the special investigation unit (SIU) for potential fraud. This role typically handles a combination of complex attorney represented and unrepresented claims and moderate to complex losses, in which suspicious activity has been identified. The individual performs a thorough investigation including; (1) conducting background searches, scene investigations, and clinic inspections; (2) taking recorded statements; (3) reviewing and analyzing medical notes, bills, and property damage; and (4) conducting witness interviews and social media searches. The individual conducts surveillance on property and/or creates scene reconstructions on some investigations and reviews whether fraud can be substantiated and supports a lawsuit. The individual provides work guidance and direction to less senior employees and provides mentoring and coaching to the team.
National General is expanding and seeking a sharp, motivated SIU Field Investigator to join our team in Richmond, VA. The ideal candidate brings a strong Auto Claims background or prior SIU experience. This team primarily investigates auto claims referred to SIU, with occasional homeowner investigations.
Allstate · Richmond, VA