SIU NY Complex PIP 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

As an Allstate SIU Investigator, your key responsibility will be to investigate claims to detect and deter fraud, in accordance with state guidelines, and within Allstate policies and procedures. Your work will be conducted remotely, reviewing potentially fraudulent insurance claims with desk model investigation techniques. You will be responsible for investigating claims and damages that may result from First-Party bodily injury claims. You may be responsible for investigating individual claims and/or involved in complex provider investigations requiring greater scrutiny. Your investigations will include analysis of injuries and treatment, interviewing involved parties and witnesses, obtaining statements and evidence, and assisting in the evaluation by providing investigative outcome recommendations. The identification of Corporate Practice of medicine, irregular/unnecessary/inflated treatment, billing patterns, exposing medical treatment networks and relationships, as well as unjust enrichment is the focus of this position. Coordination with assigned Counsel is required when preparing potential Affirmative Action and/or settlement agreements to include investigation outcomes when applicable. Occasional field travel could be expected on losses involving litigation. Key Responsibilities • Reviews investigations with fraud outcomes to validate whether denial is appropriate • Conducts complex NY No Fault PIP investigations to determine if there is fraud • 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) Preferred Qualifications • 3 or more years of PIP Casualty experience • 3 or more years SIU • NY Claims experience preferred Skills Casualty Insurance, Customer Centricity, Digital Literacy, Evidence Gathering, Fraud Investigations, Inclusive Leadership, Insurance Claim Handling, Insurance Claims, Learning Agility, Results-Oriented

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. Apply Job!