SIU Desk Investigator

Allstate; United States; A distancia; USD 60.000 - 118.000; Jornada completa

Descripción de la vacante

Allstate is seeking a Special Investigative Unit Desk Investigator to conduct complex fraud investigations and review medical notes, bills, and property damage while determining when fieldwork is needed. This remote, desk-based role involves coordinating with vendors and maintaining thorough documentation to support claim decisions.

As a significant portion of the caseload involves bodily injury claims, prior experience in Bodily Injury is preferred.

Formación

• Analytical mindset for multi-discipline investigations.
• Experience with bodily injury claims and complex fraud scenarios.
• Strong documentation and evidence-gathering capabilities.

Responsabilidades

• Enter SIU claim data into SIU systems.
• Review investigations with fraud outcomes to validate denial decisions.
• Update files with investigation outcomes and route to MCO when no fraud is found.
• Conduct complex online data searches, research, and evaluations.
• Perform site inspections for body shops, medical clinics, and loss locations.
• Investigate potentially fraudulent activities to determine payout eligibility.
• Summarize documents and document the decision-making process in claim notes.
• Use SIU tools to identify complex claims for investigation.
• Respond to complex customer communications and resolve issues.

Conocimientos

Analytical Thinking

Bodily Injury Claims

Fraud Investigations

Surveillance

Evidence Gathering

Investigative Skills

Claims Processing

Data Entry

Witness Interviewing

Excellent Communication

Descripción del empleo

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. The Special Investigative Unit Consultant II is responsible for investigating and analyzing complex, multi-discipline coverage and claims that have been referred to the Special Investigative Unit (SIU) for potential fraud. The 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. We are seeking an SIU Desk Investigator to conduct complex fraud investigations. This remote, desk-based role is responsible for claim review, interpreting medical records and demand packages, determining when field investigation is needed, coordinating with vendors, and providing recommendations to support claim decisions. As a significant portion of the caseload will involve injury claims, prior Bodily Injury claims experience is preferred.

Key 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. As a requirement of employment, individuals who currently hold an active insurance license must terminate all existing appointments prior to onboarding and must not hold any outside appointments at any point during employment. Applicants seeking an adjuster role who also hold a resident producer license must formally surrender that license when instructed to by the licensing team. By proceeding with the application process, applicants acknowledge and accept these licensing requirements and agree to comply.

Skills

• Analytical Thinking
• Bodily Injury Claims
• Claims Processing
• Complex Claims
• Critical Thinking
• Documentations
• Empathy
• Evidence Gathering
• Fraud Investigations
• Information Collection
• Insurance Claims Investigations
• Insurance Investigation
• Investigative Skills
• Personal Injury Claims
• Soft Tissue
• Special Investigations
• Surveillance
• Witness Interviewing

Compensation Base compensation offered for this role is: Special Investigative Unit Consultant I: $60,000 - $98,450 Special Investigative Unit Consultant II: $62,100 - $105,300 Special Investigative Unit Sr Consultant I: $68,500- $117,700 Annually and 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.

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. For jobs in San Francisco, for information regarding the San Francisco Fair Chance Ordinance. For jobs in Los Angeles, for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance. To view the “EEO Know Your Rights” poster. This poster provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs. To view the FMLA poster. This poster summarizing the major provisions of the Family and Medical Leave Act (FMLA) and telling employees how to file a complaint. The 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. 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. 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.

Allstate offers an environment that fosters innovative thinking where you’ll be able to explore your ideas and feel proud of the work you do. Allstate helps protect nearly 16 million households with auto, home, life, and retirement products. We want every professional connected to Allstate to be committed to giving our customers the best and that means finding the best talent. We want you to be our next great addition.