SIU Investigation Adjuster Consultant II - Remote

Location: Indiana

SIU Investigation Adjuster Consultant II - Remote page is loaded## SIU Investigation Adjuster Consultant II - Remote type:
Fully Remote locations:
US - Remote time type:
Full time posted on:
Posted Yesterday job requisition :
R25450

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
*** 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
*
* Qualifications:

*** 3+ years of previous SIU experience required
* Previous experience reviewing medical information and/or handling provider investigations
* Texas Adjuster License preferred
** Remote Home-Based Work
** This position is a permanent remote home-based role. Your home office does not need to be near an Allstate office, but it does need to be in the United States. This position is not available for California, Alaska, Hawaii, or Puerto Rico residents.
** When you work from home full time, you’ll need:
*** A home office – a dedicated workspace in your residence that is private and free from distractions
* A minimum internet bandwidth of 50 MB down/5 MB up
* Appropriate work surface and seating
* A technology bundle that includes all equipment needed to perform your work from home (laptop, monitors, headset, keyboard, mouse)
* Connectivity reimbursement of $80 per month to off set some of the cost of internet
** Notes:
** The preceding description is not designed to be a complete list of all duties and responsibilities. May be required to perform other related duties as assigned. Regular, predictable attendance is an essential function of this job.#LI-JB3
** Skills
* * Analytical Thinking, Claims Processing, Critical Thinking, Documentations, Evidence Gathering, Fraud Investigations, Information…