SIU Field 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.

** We are seeking a candidate with extensive experience in SIU claims for the SIU Field Investigator role based in the Atlanta, GA metro area. This position is responsible for investigating and analyzing complex, multi-disciplinary coverage and claims referred to the Special Investigation Unit (SIU) for potential fraud. The role typically involves handling a combination of complex attorney-represented and unrepresented claims. As this is a field-based role, the ideal candidate must be located in the Atlanta, Georgia area. **

SIU Investigator Cons I:

Key Responsibilities

• Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision-making process

• Researches and responds to moderately complex and occasionally complex customer communications, concerns, conflicts or issues

• Reviews investigations with fraud outcomes to validate whether denial is appropriate

• Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads

• Conducts thorough investigations of moderately complex and occasionally complex, multi-discipline claims that are potentially fraudulent to determine if payment is warranted, including scene investigations and surveillance as needed

• Utilizes analytic tools or SIU field intelligence to identify moderately complex and occasionally complex claims for investigation and/or for support in the evidence of the fraud and damages

• Manages vendor relationship and oversees vendor performance

• Makes claim decisions regarding moderately complex and occasionally complex investigations, and pursues restitution

• 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

Education

• 4 year Bachelors Degree (Preferred)

Experience

• 2 or more years of experience (Preferred)

SIU Investigator Cons II:

Key Responsibilities

• Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision making process

• Manages, researches, and resolves complex and occasionally highly complex customer communications, concerns, conflicts or issues

• Conducts complex and occasionally highly complex online data application searches, research, and evaluation

• 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

• Makes claim decisions regarding complex and occasionally highly complex investigations, and pursues restitution

• 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