SIU Field Investigator
GNY Insurance Companies, New York, NY, United States
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 currently seeking an SIU Field Investigator to join our team in St. Louis, Missouri. This is a field-based role covering approximately a 3-hour radius from the St. Louis area. We’re looking for candidates with prior SIU insurance experience or a strong investigative background. In this role, you’ll support a team handling investigations on a diverse mix of claims, including homeowners, auto, bodily injury, and PIP etc. Join our team at National General an Allstate company!
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 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
Experience 2 or more years of experience (Preferred)
Supervisory Responsibilities This job does not have supervisory duties.
Skills
Analytical Thinking
Claims Processing
Crime Scene Investigations
Critical Thinking
Evidence Gathering
Fraud Investigations
Information Collection
Insurance Claims
Insurance Claims Investigations
Insurance Fraud
Insurance Fraud Investigations
Insurance Investigation
Researching
Special Investigations
Time Management
Witness Interviewing
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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 currently seeking an SIU Field Investigator to join our team in St. Louis, Missouri. This is a field-based role covering approximately a 3-hour radius from the St. Louis area. We’re looking for candidates with prior SIU insurance experience or a strong investigative background. In this role, you’ll support a team handling investigations on a diverse mix of claims, including homeowners, auto, bodily injury, and PIP etc. Join our team at National General an Allstate company!
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 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
Experience 2 or more years of experience (Preferred)
Supervisory Responsibilities This job does not have supervisory duties.
Skills
Analytical Thinking
Claims Processing
Crime Scene Investigations
Critical Thinking
Evidence Gathering
Fraud Investigations
Information Collection
Insurance Claims
Insurance Claims Investigations
Insurance Fraud
Insurance Fraud Investigations
Insurance Investigation
Researching
Special Investigations
Time Management
Witness Interviewing
#J-18808-Ljbffr