What are the responsibilities and job description for the Casualty SIU Investigator Consultant II position at Allstate?
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 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.
Key Responsibilities
Reviews investigations with fraud outcomes to validate whether denial is appropriate
Conducts complex site inspections, including body shops, medical clinics, loss locations etc.
Conducts complex online data application searches, research, and evaluation
Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads
Enters SIU claim data information into multiple SIU systems
Updates files with investigation outcome, and when no fraud or insufficient evidence is found, returns file to MCO for further handling and settlement
Conducts thorough investigations of complex 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 complex claims for investigation and/or for support in the evidence of the fraud and damages
Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision-making process
Researches and responds to complex customer communications, concerns, conflicts or issues
Education
4 year Bachelors Degree (Preferred)
Experience
5 years of Casualty claims experience required
Prior SIU experience required
Excellent written and verbal communication skills
Strong organizational and computer skills
Ability to be a self-starter and work independently
Persistence and the ability to work through and solve problems
Strong analytical skills required Location and Travel Requirement
This role is not available in Alaska, Hawaii or Puerto Rico
Please note on rare occasions, you may be required to travel in the field. As a result, you must have a valid drivers license, use of a working and insured vehicle, and be willing to work a flexible schedule to accommodate customer's needs if necessary
Skills Analytical Thinking, Casualty Insurance, Claims Adjustments, Complex Claims, Documentations, Evidence Gathering, Fraud Investigations, Insurance Claims, 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.
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 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.
Key Responsibilities
Reviews investigations with fraud outcomes to validate whether denial is appropriate
Conducts complex site inspections, including body shops, medical clinics, loss locations etc.
Conducts complex online data application searches, research, and evaluation
Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads
Enters SIU claim data information into multiple SIU systems
Updates files with investigation outcome, and when no fraud or insufficient evidence is found, returns file to MCO for further handling and settlement
Conducts thorough investigations of complex 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 complex claims for investigation and/or for support in the evidence of the fraud and damages
Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision-making process
Researches and responds to complex customer communications, concerns, conflicts or issues
Education
4 year Bachelors Degree (Preferred)
Experience
5 years of Casualty claims experience required
Prior SIU experience required
Excellent written and verbal communication skills
Strong organizational and computer skills
Ability to be a self-starter and work independently
Persistence and the ability to work through and solve problems
Strong analytical skills required Location and Travel Requirement
This role is not available in Alaska, Hawaii or Puerto Rico
Please note on rare occasions, you may be required to travel in the field. As a result, you must have a valid drivers license, use of a working and insured vehicle, and be willing to work a flexible schedule to accommodate customer's needs if necessary
Skills Analytical Thinking, Casualty Insurance, Claims Adjustments, Complex Claims, Documentations, Evidence Gathering, Fraud Investigations, Insurance Claims, 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.
Salary : $56,500 - $99,963
Clinical Fraud Investigator II - SIU Fraud & Abuse
Elevance Health -
Woburn, MA
Clinical Fraud Investigator II - SIU Fraud & Abuse
Elevance Health -
Chicago, IL
Clinical Fraud Investigator II - SIU Fraud & Abuse
Elevance Health -
Louisville, KY
