SIU Investigator

About the role

This job is responsible for investigating and analyzing moderately complex auto claims referred to the Special Investigation Unit (SIU) for potential fraud. The role conducts site inspections, including body shops, medical clinics, and loss locations; performs background research; obtains recorded statements and witness interviews; reviews medical records and billing documentation; and conducts social media searches. Responsibilities include evaluating investigative findings to determine whether fraud can be substantiated and supporting potential legal action when appropriate.

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

Requirements

Seeking candidates with auto claims experience who have managed claims throughout the full claim lifecycle, including maintaining and working a pending inventory. Ideal candidates will have strong critical thinking skills, be highly organized, detail-oriented, and confident asking difficult questions to gather the information needed to move claims forward.

Qualifications

• An experienced claims adjuster with a background in auto claims
• Ability to manage claims throughout the full claim lifecycle, including maintaining and working a pending inventory
• Strong critical thinking skills
• Highly organized and detail-oriented
• Confident in asking difficult questions to gather necessary information

Skills

• Analytical Thinking
• Auto Insurance Claims
• Decision Making
• Documentations
• Fraud Detection
• Insurance Investigation
• Researching
• Witness Interviewing

Pay

• SIU Analyst III: $53,500.00 – $77,800.00/salary
• SIU Cons I: $60,000.00 – $87,400.00/salary
• SIU Cons II: $62,100.00 – $92,700.00/salary
• SIU Sr Cons I: $68,500.00 – $104,100.00/salary

Schedule

The role is remote.

Benefits

Compensation is based on experience and qualifications. Total compensation for this role may include additional components, such as incentive pay (for example, commission or bonus), if applicable.

Application Instructions

Applicants seeking an adjuster role who also hold a resident producer license must formally surrender that license when instructed to by the licensing team. By proceeding with the application process, applicants acknowledge and accept these licensing requirements and agree to comply.

Equal Opportunity Employer

Allstate provides a comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse. Employees eligible to work from home also receive a monthly connectivity reimbursement to help offset internet costs.

Community Involvement

We look for candidates with these skills to help us achieve that goal:

• Learning Agility
• Customer Centricity
• Digital Literacy
• Results-Oriented
• Inclusive Leadership