SIU Investigator

Allstate•USA - GA (Remote), GA

2d•$53,500 - $104,100•Hybrid

About The Position

This job is responsible for investigating and analyzing moderately complex auto claims referred to the Special Investigation Unit (SIU) for potential fraud. The role conducts site inspections, including body shops, medical clinics, and loss locations; performs background research; obtains recorded statements and witness interviews; reviews medical records and billing documentation; and conducts social media searches. Responsibilities include evaluating investigative findings to determine whether fraud can be substantiated and supporting potential legal action when appropriate. Are you an experienced claims adjuster who enjoys digging deeper, connecting the dots, and uncovering potential fraud? If you're naturally curious, thrive on investigative work, and enjoy following the facts wherever they lead, this could be the perfect opportunity to put your analytical and investigative skills to work in a meaningful way. As an SIU Investigator, you will investigate potentially fraudulent insurance claims, gather and analyze evidence, conduct interviews, and collaborate with claims professionals to help ensure accurate claim outcomes while protecting the organization and its customers from fraud. Seeking candidates with auto claims experience who have managed claims throughout the full claim lifecycle, including maintaining and working a pending inventory. Ideal candidates will have strong critical thinking skills, be highly organized, detail-oriented, and confident asking difficult questions to gather the information needed to move claims forward.

Requirements

Auto insurance claims experience
Managed claims throughout the full claim lifecycle, including maintaining and working a pending inventory
Strong critical thinking skills
Highly organized
Detail-oriented
Confident asking difficult questions to gather the information needed to move claims forward
Analytical Thinking
Documentations
Fraud Detection
Insurance Investigation
Researching
Witness Interviewing

Responsibilities

Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision-making process
Researches and responds to moderately complex and occasionally complex customer communications, concerns, conflicts or issues
Reviews investigations with fraud outcomes to validate whether denial is appropriate
Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads
Conducts thorough investigations of moderately complex and occasionally complex, multi-discipline claims that are potentially fraudulent to determine if payment is warranted, including scene investigations and surveillance as needed
Utilizes analytic tools or SIU field intelligence to identify moderately complex and occasionally complex claims for investigation and/or for support in the evidence of the fraud and damages
Manages vendor relationship and oversees vendor performance
Makes claim decisions regarding moderately complex and occasionally complex investigations, and pursues restitution
Enters SIU claim data information into multiple SIU systems
Updates files with investigation outcome, and when no fraud, or if insufficient evidence is found, returns file to MCO for further handling and settlement