SIU Field Investigator
About The Position
National General, part of The Allstate Corporation, is hiring an SIU Field Investigator for its Special Investigations Unit Fraud Investigation Department in Northern California. This field-based role conducts in-depth investigations of potentially fraudulent insurance claims, analyzes claim information, identifies fraud indicators, and gathers evidence to support well-founded conclusions. The preferred candidate will be based in or near San Francisco, Oakland, San Jose, Sacramento, or surrounding commuting areas and will service the broader region. A strong background in investigations and insurance is preferred. The investigator uses critical thinking, interviewing, research, and analytical skills to resolve complex questions, determine whether claim payments are warranted, and help protect customers and the business from potential fraud. Work includes field investigations and analysis of claim data, with findings and decision-making documented in claim and SIU systems.
Requirements
- Strong background in investigations and insurance is preferred.
- Skills in analytical thinking, critical thinking, decision-making, documentation, evidence gathering, fraud investigations, insurance claims investigations, interviewing, investigative work, problem analysis, special investigations, and time management.
Nice To Haves
- Based in or around San Francisco, Oakland, San Jose, Sacramento, or the surrounding commuting areas.
- Strong background in both investigations and insurance.
Responsibilities
- Enter SIU claim data into multiple SIU systems.
- Review investigations with fraud outcomes to validate whether denial is appropriate.
- Update files with investigation outcomes and return files to MCO for further handling and settlement when no fraud or insufficient evidence is found.
- Conduct complex online data application searches, research, and evaluation.
- Conduct complex site inspections at locations such as body shops, medical clinics, and loss locations.
- Investigate complex claims that may be fraudulent to determine whether payment is warranted, including scene investigations and surveillance as needed.
- Validate information provided and obtained through investigations and follow up on all possible leads.
- Summarize documents and enter claim system notes documenting the claim file, evaluations, and decision-making process.
- Use analytic tools or SIU field intelligence to identify complex claims for investigation or support evidence of fraud and damages.
- Research and respond to complex customer communications, concerns, conflicts, or issues.
Benefits
- Comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse.
- Monthly connectivity reimbursement for employees eligible to work from home.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
