Senior SIU Investigator

Summary

At Allstate, great things happen when our people work together to protect families and their belongings from life's uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers' evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.**Job Description**This job is responsible for investigating and analyzing complex and occasionally highly 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 complex losses and claims involving extra-contractual liability. Claims investigated are primarily for accident insurance and health insurance policies. 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 conducting witness interviews and social media searches. The individual reviews whether fraud can be substantiated and supports a lawsuit.**Key Responsibilities**• Makes claim decisions regarding complex and occasionally highly complex investigations, and pursues restitution• Manages, researches, and resolves complex and occasionally highly complex customer communications, concerns, conflicts or issues• Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads• Conducts thorough investigations of complex and occasionally highly complex multi-discipline claims and ECL claims that are potentially fraudulent to determine if payment is warranted• Utilizes analytic tools or SIU field intelligence to identify complex and occasionally highly complex claims for investigation and/or for support in the evidence of the fraud and damages• Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision making process• Enters SIU claim data information into multiple SIU systems• Updates files with investigation outcome, and when no fraud, or if insufficient evidence is found, returns file to MCO for further handling and settlement• Reviews investigations with fraud outcomes to validate whether denial is appropriate• Conducts complex and occasionally highly complex online data application searches, research, and evaluation• 3+ years of investigative experience (Preferred)### ### #LI-JH1 ### ### **Skills**Claims Processing, Critical Thinking, Fraud Investigations, Information Collection, Insurance, Insurance Investigation, Process Improvements, Special Investigations**Compensation**Compensation offered for this role is 68,500.00 - 115,600.00 annually and is based on experience and qualifications.#J-18808-Ljbffr

Job Description

At Allstate, great things happen when our people work together to protect families and their belongings from life's uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers' evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.**Job Description**This job is responsible for investigating and analyzing complex and occasionally highly 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 complex losses and claims involving extra-contractual liability. Claims investigated are primarily for accident insurance and health insurance policies. 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 conducting witness interviews and social media searches. The individual reviews whether fraud can be substantiated and supports a lawsuit.**Key Responsibilities**• Makes claim decisions regarding complex and occasionally highly complex investigations, and pursues restitution• Manages, researches, and resolves complex and occasionally highly complex customer communications, concerns, conflicts or issues• Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads• Conducts thorough investigations of complex and occasionally highly complex multi-discipline claims and ECL claims that are potentially fraudulent to determine if payment is warranted• Utilizes analytic tools or SIU field intelligence to identify complex and occasionally highly complex claims for investigation and/or for support in the evidence of the fraud and damages• Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision making process• Enters SIU claim data information into multiple SIU systems• Updates files with investigation outcome, and when no fraud, or if insufficient evidence is found, returns file to MCO for further handling and settlement• Reviews investigations with fraud outcomes to validate whether denial is appropriate• Conducts complex and occasionally highly complex online data application searches, research, and evaluation• 3+ years of investigative experience (Preferred)### ### #LI-JH1 ### ### **Skills**Claims Processing, Critical Thinking, Fraud Investigations, Information Collection, Insurance, Insurance Investigation, Process Improvements, Special Investigations**Compensation**Compensation offered for this role is 68,500.00 - 115,600.00 annually and is based on experience and qualifications.#J-18808-Ljbffr