Michigan PIP SIU Investigator (CST/EST) - Remote

Job Summary:

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.

A Day in the Life:

• Investigating No Fault claims to detect or deter fraud in accordance with state guidelines and Allstate policies and procedures
• Investigating claims and damages resulting from First Party PIP claims
• Investigations include the analysis of injuries, performing background and social media searches, obtaining evidence, interviewing parties and witnesses, verifying policy coverage and limits, reviewing medical records and bills, and assisting in the evaluation of potentially fraudulent claims.
• Communicate empathetically with customers and help them through their claim process in a fast, fair and easy manner
• Working in a flexible environment investigating potentially fraudulent insurance claims

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 online data application searches, research, and evaluation
• 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 

Job Qualifications:

• 2 years of PIP experience, strongly preferred
• Casualty claims handling, a plus
• Med-Pay experience, a plus
• High School Diploma/GED or higher (Bachelor’s Degree preferred)
• Have a passion for investigation and cutting insurance fraud out of the system 
• Value providing an effortless customer service experience
• Are organized and able to multi-task in a fast-paced environment
• Possess clear and professional communication skills – both written and verbal
• Being bilingual and/or having prior military experience is a plus
• Applies broad knowledge of insurance policy, coverage, and regulation
• Applies broad knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards
• Applies broad knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data
• Applies broad knowledge of problem solving and preparation of reports for analysis
• Applies broad negotiation and/or arbitration skills
• Ability to investigate, evaluate, negotiate and settle complex claims
• Applies broad knowledge of training facilitation and coaching skills

What We Offer:

• Generous Paid Time Off
• Tuition Reimbursement
• Internet reimbursement
• Medical, Dental, and Vision coverage (cafeteria style health insurance plane - starts day one!)
• 401(k) match and pension plan
• A culture of learning where you can expect to develop foundational skills for the future
• Opportunities for both personal and professional development
• Leadership teams that are communicative and engaged
• Volunteer opportunities & donation program
• Recognition and advancement opportunities
• Learn more about Allstate benefits @ https://allstategoodlife.com

Additional Information:

• Employees who have been in their current role for at least one year will receive screening preference
• In our virtual environment, employees are required to engage and participate on camera during online meetings and trainings
• This position is eligible for a monthly connectivity reimbursement to offset the costs of internet and phone expenses
• This position is not available for Puerto Rico, California, New York, Alaska and Hawaii residents
• 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