SIU Field Investigator
Crains Cleveland, New York, NY, United States
Description
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 background searches, scene investigations, and clinic inspections; takes recorded statements; reviews and analyzes medical notes, bills, and property damage; conducts 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.
National General Insurance is currently seeking an experienced SIU Field Investigator to join our Special Investigations Unit (SIU) in New York! This is a field-based, location-specific position, and the ideal candidate will reside in or near Nassau County, Suffolk County, Brooklyn, Queens, or the surrounding areas.
Key Responsibilities
Enter SIU claim data information into multiple SIU systems
Review investigations with fraud outcomes to validate whether denial is appropriate
Update files with investigation outcome, and when no fraud or insufficient evidence is found, return file to MCO for further handling and settlement
Conduct complex online data application searches, research, and evaluation
Conduct complex site inspections, including body shops, medical clinics, loss locations, etc.
Conduct thorough investigations of complex claims that are potentially fraudulent to determine if payment is warranted, including scene investigations and surveillance as needed
Validate that the information provided and obtained through investigation is true and accurate and follow up on all possible leads
Summarize documents and enter into claim system notes, documenting a claim file with notes, evaluations and decision-making process
Utilize analytic tools or SIU field intelligence to identify complex claims for investigation and/or for support in the evidence of the fraud and damages
Research and respond to complex customer communications, concerns, conflicts or issues
This position does not have supervisory duties.
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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 background searches, scene investigations, and clinic inspections; takes recorded statements; reviews and analyzes medical notes, bills, and property damage; conducts 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.
National General Insurance is currently seeking an experienced SIU Field Investigator to join our Special Investigations Unit (SIU) in New York! This is a field-based, location-specific position, and the ideal candidate will reside in or near Nassau County, Suffolk County, Brooklyn, Queens, or the surrounding areas.
Key Responsibilities
Enter SIU claim data information into multiple SIU systems
Review investigations with fraud outcomes to validate whether denial is appropriate
Update files with investigation outcome, and when no fraud or insufficient evidence is found, return file to MCO for further handling and settlement
Conduct complex online data application searches, research, and evaluation
Conduct complex site inspections, including body shops, medical clinics, loss locations, etc.
Conduct thorough investigations of complex claims that are potentially fraudulent to determine if payment is warranted, including scene investigations and surveillance as needed
Validate that the information provided and obtained through investigation is true and accurate and follow up on all possible leads
Summarize documents and enter into claim system notes, documenting a claim file with notes, evaluations and decision-making process
Utilize analytic tools or SIU field intelligence to identify complex claims for investigation and/or for support in the evidence of the fraud and damages
Research and respond to complex customer communications, concerns, conflicts or issues
This position does not have supervisory duties.
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