SIU Desk Investigator

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 The Special Investigative Unit Consultant II is responsible for investigating and analyzing complex, multi-discipline coverage and claims that have been referred to the Special Investigative Unit (SIU) for potential fraud. The 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. We are seeking an SIU Desk Investigator to conduct complex fraud investigations. This remote, desk-based role is responsible for claim review, interpreting medical records and demand packages, determining when field investigation is needed, coordinating with vendors, and providing recommendations to support claim decisions. As a significant portion of the caseload will involve injury claims, prior Bodily Injury claims experience is preferred. Key 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 Supervisory Responsibilities • This job does not have supervisory duties. As a requirement of employment, individuals who currently hold an active insurance license must terminate all existing appointments prior to onboarding and must not hold any outside appointments at any point during employment. Applicants seeking an adjuster role who also hold a resident producer license must formally surrender that license when instructed to by the licensing team. By proceeding with the application process, applicants acknowledge and accept these licensing requirements and agree to comply. #LI-KR1 Skills Analytical Thinking, Bodily Injury Claims, Claims Processing, Complex Claims, Critical Thinking, Documentations, Empathy, Evidence Gathering, Fraud Investigations, Information Collection, Insurance Claims In