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New Jersey Pip Siu Investigator Consultant

3 months ago

Chicago, United States Allstate Full time

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.

The New Jersey SIU PIP Investigator 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**
- Researches and responds to complex customer communications, concerns, conflicts or issues
- 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
- 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
- Conducts complex site inspections, including body shops, medical clinics, loss locations etc.
- 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
- Enters SIU claim data information into multiple SIU systems
- Makes claim decisions regarding complex investigations, and pursues restitution

**Preferred Qualifications**
- 2+ years of SIU experience preferred
- PIP/Casualty experience preferred
- Bachelor's degree preferred

**Functional Skills**
- Litigation experience preferred
- Familiarity with Complex Case development and Singular Referrals / Cases
- 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

**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.

**Skills**

Medical Claims, Personal Injury Claims, Special Investigations, Third Party Claims

**Compensation**

Compensation offered for this role is $52,260 - 92,790 annually and is based on experience and qualifications.

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.

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