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.

** This is a field role with the SIU Fraud investigation department, conducting fraud investigations. Ideal candidate must be based in the state of Louisiana. Would prefer this candidate to have a combination of experience in investigation, insurance and/or law enforcement ** 

SIU Investigation Adjuster Senior Consultant I

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 is appropriate

Education

• 4 year Bachelors Degree (Preferred)

Experience

• 3 or more years of experience (Preferred)

Supervisory Responsibilities

• This job does not have supervisory duties.

Education & Experience (in lieu)

• In lieu of the above education requirements, an equivalent combination of education and experience may be considered.

Adjuster SIU Investigator Consultant II

Key Responsibilities

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

• Conducts complex site inspections, including body shops, medical clinics, loss locations etc.

• Conducts 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

• Enters SIU claim data information into multiple SIU systems

• Updates files with investigation outcome, and when no fraud or insufficient evidence is found, returns file to MCO for further handling and settlement

• Conducts thorough investigations of complex 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 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

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

Education