SIU Investigation Senior Adjuster

Wells Media Group; Jacksonville (FL); Hybrid; USD 70,000 - 139,000; Full time

Benefits offered by this job

Laptop and monitors provided

Connectivity reimbursement for home/wh

Job summary

National General is seeking an experienced SIU Investigator to handle highly complex fraud investigations across Northeast Florida, with a preference for Jacksonville area residents. You will conduct background checks, scene inspections, statements, and data reviews, determine fraud substantiation, and support potential lawsuits.

Role includes overseeing file quality, making claim decisions, managing vendor performance, and utilizing SIU tools to flag complex claims, while adhering to licensing

Qualifications

• 4 year Bachelor's Degree (Preferred).
• 3 or more years of experience (Preferred).

Responsibilities

• Oversees file quality Investigative Consultant
• Makes claim decisions regarding highly complex investigations, and pursues restitution
• Manages vendor relationship and oversees vendor performance
• Conducts highly complex online data application searches, research, and evaluation
• Conducts thorough investigations of highly complex, multi-discipline claims and Excess Coverage Liability (ECL) claims that are potentially fraudulent to determine if payment is warranted
• Reviews investigations with fraud outcomes to validate whether denial is appropriate
• Conducts highly complex site inspections, including body shops, medical clinics, loss locations etc.
• Manages, researches, and resolves highly complex customer communications, concerns, conflicts or issues
• Utilizes analytic tools or SIU field intelligence to identify 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

Skills

Claims Processing

Critical Thinking

Fraud Investigations

Information Collection

Insurance Investigation

Education

4 year Bachelor’s Degree

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 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 large or significant losses and claims involving highly complex extra-contractual liability, large fire and property losses where 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; (4) and conducting witness interviews and social media searches. The individual reviews whether fraud can be substantiated and supports a lawsuit. At this level, the individual is expected to handle the most complex or specialized claims or claims involving significant dollar exposure or customers.

We are seeking an experienced SIU Investigator to join our team! This territory covers Northeast Florida, with a strong preference for candidates located near Jacksonville, FL. Candidates residing in Jacksonville or within a reasonable daily commuting distance will be well-positioned to support the assigned region.

Key Responsibilities

• Oversees file quality Investigative Consultant
• Makes claim decisions regarding highly complex investigations, and pursues restitution
• Manages vendor relationship and oversees vendor performance
• Conducts highly complex online data application searches, research, and evaluation
• Conducts thorough investigations of highly complex, multi-discipline claims and Excess Coverage Liability (ECL) claims that are potentially fraudulent to determine if payment is warranted
• Reviews investigations with fraud outcomes to validate whether denial is appropriate
• Conducts highly complex site inspections, including body shops, medical clinics, loss locations etc.
• Manages, researches, and resolves highly complex customer communications, concerns, conflicts or issues
• Utilizes analytic tools or SIU field intelligence to identify 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

Education

• 4 year Bachelors Degree (Preferred)

Experience

• 3 or more years of experience (Preferred)

Supervisory Responsibilities

• This job does not have supervisory duties.

Skills

Claims Processing, Critical Thinking, Fraud Investigations, Information Collection, Insurance Investigation

Compensation

Base compensation offered for this role is: SIU Field Adjuster Sr Cons II: $70,000 - $138,600 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.

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.

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.

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.

National General Holdings Corp., a member of the Allstate family of companies, is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A– (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.

Companies & Partners

Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.

Benefits

• National General Holdings Corp. is an Equal Opportunity (EO) employer – Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas. In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at [phone].
• 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.