National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.

JOB DESCRIPTION

This job is responsible for investigating and analyzing complex and occasionally highly 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 complex losses and claims involving extra-contractual liability, large fire and property 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 (3) conducting witness interviews and social media searches. The individual reviews whether fraud can be substantiated and supports a lawsuit.
* We’re looking for a SIU Field Investigator to join our team in Northern California. This is a field-based role within the SIU (Special Investigations Unit) Fraud Investigation Department, responsible for conducting in-depth fraud investigations related to insurance claims. The preferred candidate should be based in or around San Francisco, Oakland, San Jose, Sacramento, or the surrounding commuting areas, as they will be expected to service the broader region. The ideal candidate will have a strong background in both investigations and insurance. *

EDUCATION

• 4 year Bachelors Degree (Preferred)

EXPERIENCE

• 3 or more years of experience (Preferred)

EDUCATION & EXPERIENCE (IN LIEU)

• In lieu of the above education requirements, an equivalent combination of education and experience may be considered.
  

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KEY RESPONSIBILITIES

• Makes claim decisions regarding complex and occasionally highly complex investigations, and pursues restitution
• Manages, researches, and resolves complex and occasionally highly complex customer communications, concerns, conflicts or issues
• Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads
• Conducts thorough investigations of complex and occasionally highly complex multi-discipline claims and ECL claims that are potentially fraudulent to determine if payment is warranted
• Utilizes analytic tools or SIU field intelligence to identify complex and occasionally highly 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
• 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
• Reviews investigations with fraud outcomes to validate whether denial is appropriate
• Conducts complex and occasionally highly complex online data application searches, research, and evaluation