SIU Investigator

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. National Insurance is currently seeking an experienced SIU Field Investigator to join our Special Investigations Unit (SIU) in New York! This is a field-based, location-specific position, and the ideal candidate will reside in or near Nassau County, Suffolk County, Brooklyn, Queens, or the surrounding areas. 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 at of the fraud and damage s Researches and responds to complex customer communications Supervisory Responsibilities This job does not have supervisory duties. #J-18808-Ljbffr