Senior SIU Investigation Adjuster

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

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.

The candidate(s) offered this position will be required to submit to a background investigation.

Joining our team isn't just a job - it's an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. One where you can shape the future of protection while supporting causes that mean the most to you. Joining our team means being part of something bigger - a winning team making a meaningful impact.

Allstate generally does not sponsor individuals for employment-based visas for this position.

Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.

It is the Company's policy to employ the best qualified individuals available for all jobs. Therefore, any discriminatory action taken on account of an employee's ancestry, age, color, disability, genetic information, gender, gender identity, gender expression, sexual and reproductive health decision, marital status, medical condition, military or veteran status, national origin, race (include traits historically associated with race, including, but not limited to, hair texture and protective hairstyles), religion (including religious dress), sex, or sexual orientation that adversely affects an employee's terms or conditions of employment is prohibited. This policy applies to all aspects of the employment relationship, including, but not limited to, hiring, training, salary administration, promotion, job assignment, benefits, discipline, and separation of employment.

Allstate provides a comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse. Employees eligible to work from home also receive a monthly connectivity reimbursement to help offset internet costs.

When working from home, you must have a dedicated, private workspace free from distractions, along with appropriate desk and seating. Reliable internet is required, with minimum speeds of 50 MB download and 5 MB upload.

To help create a more personal and engaging experience, we ask that you join with your camera on if your interview is virtual. Please also have a Valid Photo Identification available at the start of your interview. If you require any accommodations or have questions ahead of your interview please reach out to your recruiter.

Note: Internal candidates are only asked to join on video; a Valid Photo Identification is not needed for the interview.