Field SIU Investigation Property/Casualty

Responsibilities

• 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.
• #LI-AS2

Requirements

• Adaptability, Analytical Thinking, Curious Mindset, Documentations, Fraud Detection, Fraud Investigations, Fraud Monitoring, Prioritization, Property & Casualty Insurance, Property Damage, Special Investigations

Benefits

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 As a Field SIU Investigation Property/Casualty you will be 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. We are seeking an experienced Field SIU Investigator to handle Personal Auto Property and Casualty claims, with some exposure to commercial auto. The ideal candidate will bring direct SIU experience working for an insurance carrier and have a strong background in either property or casualty investigations. This person should be comfortable working in the field, conducting detailed and thorough investigations, and adapting to changing priorities. Strong attention to detail, independence, and investigative curiosity are key to success in this role. Candidates must reside within or be able to cover the Orlando, Florida territory, including Osceola, Seminole, Volusia, or Lake County.

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