SIU Investigation Adjuster Consultant

SIU Investigation Adjuster Consultant at Allstate

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. For more than 90 years, our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.

This SIU Investigation Adjuster Consultant role 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.

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 cases 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.

Qualifications

• 3+ years of previous SIU experience required.
• Previous experience reviewing medical information and/or handling provider investigations.
• Texas Adjuster License preferred.

Work Arrangement

This position is a permanent remote home-based role within the United States, excluding California, Alaska, Hawaii, or Puerto Rico residents. When working from home full time, you'll need a dedicated, private workspace free from distractions, a minimum internet bandwidth of 50 MB down/5 MB up, and appropriate work surface and seating. Allstate will provide a technology bundle, including a laptop, monitors, headset, keyboard, and mouse, along with a $80 per month connectivity reimbursement.

Compensation

Compensation offered for this role is $62,100.00 - $103,950.00 annually and is based on experience and qualifications.

Key skills/competency

• Fraud Investigations
• Claims Analysis
• Evidence Gathering
• Analytical Thinking
• Medical Review
• Background Searches
• Site Inspections
• Data Research
• Critical Thinking
• Mentorship