Field - SIU Adjuster - National General

National General is part of The Allstate Corporation, offering home, auto, accident, health insurance, and other specialty niche insurance products through a large network of independent insurance agents and directly to consumers.

About the role

This role is responsible for investigating and analyzing complex, multi-discipline coverage and claims referred to the Special Investigation Unit (SIU) for potential fraud. The Field SIU Investigator handles a combination of complex attorney-represented and unrepresented claims, as well as moderate to complex losses where suspicious activity has been identified. Serving Los Angeles County and the Southern California region, you will lead complex fraud investigations, conduct surveillance and witness interviews, analyze evidence, and determine fraud exposure.

Responsibilities

• Enter SIU claim data into multiple SIU systems.
• Review investigations with fraud outcomes to validate whether denial is appropriate.
• Update files with investigation outcomes; return files to MCO for further handling and settlement when no fraud or insufficient evidence is found.
• Conduct complex online data application searches, research, and evaluation.
• Perform site inspections, including body shops, medical clinics, and loss locations.
• Conduct thorough investigations of potentially fraudulent complex claims, including scene investigations and surveillance as needed.
• Validate information obtained through investigation for accuracy and follow up on all possible leads.
• Summarize documents and enter them into claim system notes, documenting evaluations and decision-making processes.
• Utilize analytic tools or SIU field intelligence to identify complex claims for investigation and support evidence of fraud and damages.
• Research and respond to complex customer communications, concerns, conflicts, or issues.
• Perform surveillance on property and/or create scene reconstructions on some investigations.
• Provide work guidance, mentoring, and coaching to less senior employees.

Requirements

• 2 or more years of experience in fraud investigations or related field (preferred).

Skills

• Analytical Thinking
• Claims Processing
• Critical Thinking
• Documentation
• Evidence Gathering
• Fraud Investigations
• Information Collection
• Insurance Claims Investigations
• Insurance Investigation
• Investigative Interviewing
• Surveillance

Pay

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

Benefits

• Comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse.
• Monthly connectivity reimbursement to help offset internet costs for eligible remote employees.

Remote work requirements include a dedicated, private workspace free from distractions, appropriate desk and seating, and reliable internet with minimum speeds of 50 MB download and 5 MB upload.