SIU Field Investigator Senior Consultant I - National General

Allstate • California, KY

385d • $62,800 - $97,050

About The Position

The SIU Field Investigator Senior Consultant I role at National General involves investigating and analyzing complex insurance claims referred to the Special Investigation Unit (SIU) for potential fraud. This position requires conducting thorough investigations, including background searches, scene investigations, and interviews, to determine the validity of claims and support legal actions if necessary. The ideal candidate will have a combination of investigative and insurance experience, and will work primarily in the field within the greater San Francisco area.

Requirements

• 4 year Bachelor's Degree (Preferred)
• 3 or more years of experience in investigation and insurance (Preferred)
• Equivalent combination of education and experience may be considered.

Responsibilities

• Summarizes documents and enters notes into the claim system, documenting the claim file with evaluations and decision-making processes.
• Manages, researches, and resolves complex customer communications, concerns, conflicts, or issues.
• Conducts complex online data application searches, research, and evaluation.
• Validates the accuracy of information obtained through investigations and follows up on all possible leads.
• Conducts thorough investigations of complex multi-discipline claims and extra-contractual liability claims that are potentially fraudulent to determine if payment is warranted.
• Utilizes analytic tools or SIU field intelligence to identify complex claims for investigation and support evidence of fraud and damages.
• Makes claim decisions regarding complex investigations and pursues restitution.
• Enters SIU claim data information into multiple SIU systems.
• Updates files with investigation outcomes, returning files to MCO for further handling and settlement when no fraud or insufficient evidence is found.
• Reviews investigations with fraud outcomes to validate whether denial is appropriate.

Benefits

• Competitive salary based on experience and qualifications.
• Flexible work environment that embraces connection and belonging.
• Recognition of inclusivity and diversity awards.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree