SIU Field Investigator - National General

Allstate Foundation; Chicago (IL); On-site; USD 75,000 - 110,000; Full time

Job summary

National General, part of The Allstate Corporation, seeks an experienced SIU Investigator to join a growing team handling complex fraud across Auto, Homeowners, and Specialty Lines. This field-based role covers a territory within roughly three hours of Chicago, IL, requiring prior SIU experience and a track record of identifying and resolving suspicious claims.

Responsibilities include data entry in SIU systems, reviewing investigations for outcomes, and coordinating with MCO and settlements.

Qualifications

• Experience in fraud investigations and claim analysis preferred.
• Ability to conduct background searches, site inspections and witness interviews.
• Strong analytical and documentation skills for complex claims.

Responsibilities

• Enter SIU data into multiple SIU systems.
• Review investigations to validate fraud outcomes and denials.
• Update files with outcomes and coordinate with MCO for settlements.

Skills

Analytical Thinking

Claims Processing

Critical Thinking

Evidence Gathering

Fraud Investigation

Fraud Investigations

Information Collection

Insurance Claims Investigations

Insurance Investigation

Investigative Research

Investigative Skills

Researching

Job description

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

This job is 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 SIU Investigator to join our growing team! This role is responsible for conducting complex fraud investigations across multiple lines of business, including Auto, Homeowners, and Specialty Lines. This is a field-based position supporting a territory within approximately a three-hour radius of Chicago, IL. Prior investigative experience is required, with a strong preference for candidates who have a Special Investigations Unit (SIU) background and a proven track record of identifying, investigating, and resolving suspicious claims.

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
• Claims Processing
• Critical Thinking
• Evidence Gathering
• Fraud Investigation
• Fraud Investigations
• Information Collection
• Insurance Claims Investigations
• Insurance Investigation
• Investigative Research
• Investigative Skills
• Researching