Remote

Position SIU NY/New England PIP Singular Investigator

Allstate Insurance
United States, Illinois
Nov 23, 2024
At Allstate, great things happen when our people work together to protect families and their belongings from life's uncertainties. And 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. 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 in which suspicious activity has been identified. The individual performs a thorough investigation including; (1) conducting background searches, scene investigations (2) taking recorded statements; (3) reviewing and analyzing medical notes, bills, and property damage; and (4) conducting witness interviews and social media searches. Job Description Key Responsibilities: Researches and responds to complex customer communications, concerns, conflicts or issues 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 Conducts thorough investigations of complex that are potentially fraudulent to determine if payment is warranted Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads Conducts complex online data application searches, research, and evaluation 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 Enters SIU claim data information into multiple SIU systems Makes claim decisions regarding complex investigations, and pursues restitution This role handles claims in New York and New England Preferred Qualifications: Bachelor's Degree or equivalent preferred SIU experience preferred 3 years claims handling experience required PIP and MED PAY experience is a plus Certificates, Licenses, Registrations: New England licenses in CT, MA and RI are a plus Notes: The preceding description is not designed to be a complete list of all duties and responsibilities. May be required to perform other related duties as assigned. Regular, predictable attendance is an essential function of this job. #LI-AC3 Skills Analytical Thinking, Casualty Insurance, Communication, Customer Interactions, Customer Service, Evidence Gathering, Insurance Fraud Investigations, Negotiation, Researching, Special Investigations Compensation Compensation offered for this role is $56,500.00 - 99,962.50 annually and is based on experience and qualifications. The candidate(s) offered this position will be required to submit to a background investigation. Joining our team isn't just a job - it's an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. And one where you can impact the future for the greater good. You'll do all this in a flexible environment that embraces connection and belonging. And with the recognition of several inclusivity and diversity awards, we've proven that Allstate empowers everyone to lead, drive change and give back where they work and live. Good Hands. Greater Together. Allstate generally does not sponsor individuals for employment-based visas for this position. Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component. For jobs in San Francisco, please click "here" for information regarding the San Francisco Fair Chance Ordinance. For jobs in Los Angeles, please click "here" for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance. To view the "EEO is the Law" poster click "here". This poster provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs To view the FMLA poster, click "here". This poster summarizing the major provisions of the Family and Medical Leave Act (FMLA) and telling employees how to file a complaint. It is the Company's policy to employ the best qualified individuals available for all jobs. Therefore, any discriminatory action taken on account of an employee's ancestry, age, color, disability, genetic information, gender, gender identity, gender expression, sexual and reproductive health decision, marital status, medical condition, military or veteran status, national origin, race (include traits historically associated with race, including, but not limited to, hair texture and protective hairstyles), religion (including religious dress), sex, or sexual orientation that adversely affects an employee's terms or conditions of employment is prohibited. This policy applies to all aspects of the employment relationship, including, but not limited to, hiring, training, salary administration, promotion, job assignment, benefits, discipline, and separation of employment.