SIU PIP Investigator

Allstate • USA - MI (Remote), MI

3d • $62,100 - $103,950 • Remote

About The Position

This job is responsible for investigating and analyzing complex Michigan PIP 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; (1) conducting background searches, scene investigations, and clinic inspections; (2) taking recorded statements; (3) reviewing and analyzing medical notes, bills, and property damage; and (4) conducting 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. The ideal candidate is detail‑oriented, proactive, and adaptable, with the ability to manage multiple priorities in a fast‑paced environment. You bring a strong understanding of PIP regulations, demonstrate sound judgment, and consistently apply a thorough, analytical approach to claim investigations. Experience handling Michigan state PIP claims is highly desirable.

Requirements

• Analytical Thinking
• Bodily Injury Claims
• Decision Making
• Fraud Analysis
• Fraud Auditing
• Fraud Investigations
• Injury Treatment
• Investigative Skills
• Medical Record Reviews
• Personal Injury Claims
• Personal Injury Protection
• Special Investigations
• Experience handling Michigan state PIP claims is highly desirable.

Responsibilities

• Enters SIU claim data information into multiple SIU systems
• 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
• Conducts complex online data application searches, research, and evaluation
• Conducts complex site inspections, including body shops, medical clinics, loss locations etc.
• Conducts thorough investigations of complex that are potentially fraudulent to determine if payment is warranted, including scene investigations and surveillance as needed
• Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads
• 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
• Researches and responds to complex customer communications, concerns, conflicts or issues

Benefits

• Comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse.
• Monthly connectivity reimbursement for eligible remote employees.
• Dedicated, private workspace free from distractions, along with appropriate desk and seating (for remote work).
• Reliable internet with minimum speeds of 50 MB download and 5 MB upload (for remote work).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed