Senior SIU Fraud Investigator (Remote)

Insurance Journal; Springfield (IL); On-site; USD 69,000 - 116,000; Full time

Job summary

Allstate is seeking a Special Investigations professional to analyze complex and highly sophisticated claims referred to SIU for potential fraud. The role involves background searches, scene investigations, and interviewing witnesses while coordinating with the MCO and other stakeholders to determine payment eligibility.

The ideal candidate has 3+ years of investigative experience, strong analytical skills, and a track record in handling attorney-represented and unrepresented claims across auto

Qualifications

• Experience handling complex investigations and claims.
• Ability to review medical notes, bills, and damage for fraud indicators.
• Strong analytic, investigative, and documentation skills.

Responsibilities

• Makes claim decisions on complex investigations and pursues restitution.
• Manages complex customer communications and resolves issues.
• Validates information from investigations and follows up on leads.
• Conducts thorough investigations of multi-discipline claims to determine payment viability.
• Uses SIU tools to identify claims for investigation and evidence collection.
• Documents notes and outcomes in the claim system with clear rationale.
• Enters SIU data into multiple systems and updates files as needed.
• Reviews investigations with fraud outcomes to ensure appropriate denial or payment.
• Conducts online data searches and evaluative research.
• Requires 3+ years of investigative experience.

Skills

Claims Processing

Critical Thinking

Fraud Investigations

Information Collection

Insurance

Insurance Investigation

Process Improvements

Special Investigations

Job description

Allstate is seeking a Special Investigations professional to analyze complex and highly sophisticated claims referred to SIU for potential fraud. The role involves background searches, scene investigations, and interviewing witnesses while coordinating with the MCO and other stakeholders to determine payment eligibility.

The ideal candidate has 3+ years of investigative experience, strong analytical skills, and a track record in handling attorney-represented and unrepresented claims across auto