Special Investigation Unit - Investigator - Bodily Injury

The world isn’t standing still, and neither is Allstate. We’re moving quickly, looking across our businesses and brands and taking bold steps to better serve customers’ evolving needs. That’s why now is an exciting time to join our team. You’ll have opportunities to take risks, challenge the status quo and shape the future for the greater good.

You’ll do all this in an environment of excellence and the highest ethical standards – a place where values such as integrity, inclusive diversity and accountability are paramount. We empower every employee to lead, drive change and give back where they work and live. Our people are our greatest strength, and we work as one team in service of our customers and communities.

Everything we do at Allstate is driven by a shared purpose: to protect people from life’s uncertainties so they can realize their hopes and dreams. For more than 89 years we’ve thrived by staying a step ahead of whatever’s coming next – to give customers peace of mind no matter what changes they face. We acted with conviction to advocate for seat belts, air bags and graduated driving laws. We help give survivors of domestic violence a voice through financial empowerment. We’ve been an industry leader in pricing sophistication, telematics, digital photo claims and, more recently, device and identity protection.

We are the Good Hands. We don’t follow the trends. We set them.

Job Summary:

Special Investigative Unit (SIU) work is performed by a specialized unit that proactively utilizes analytical tools to handle the most complex or specialized claims possibly in litigation and works with specialized counsel and law enforcement to detect, investigate, prosecute and deter fraud.

Under limited supervision, 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 is responsible for working parallel with the Claim Owner during the Investigation of all SIU issues that have been identified. The individual 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. The individual also delivers compassionate service that is fast, fair, and easy, to ensure customer retention. The individual works independently, prioritizing the individual's own responsibilities, and managing the individual's own workload. The individual also consistently meets band level behaviors, production, quality, and/or customer service goals.

Key Responsibilities:

Customer Service

• Makes and maintains a connection with the customer by understanding and meeting their needs; serves the customer with empathy; and follows up to ensure that customer needs have been met
• Researches and responds to complex customer communications, concerns, conflicts or issues
• Participates in determining necessary personal and business unit action plans

File Documentation and Reporting

• Summarizes documents and enters into claim system notes and multiple Special Investigation Unit systems
• Documents a claim file with notes, evaluations and decision making process

SIU (Post-Referral)

• Verifies loss facts and coverage
• Utilizes analytic tools or Special Investigation Unit field intelligence to identify complex claims for investigation and/or for support in the evidence of the fraud and damages
• Attends industry, law enforcement and National Insurance Crime Bureau meetings to obtain information on latest fraud schemes
• Conducts thorough investigations of complex, attorney represented or unrepresented multi-discipline claims that are potentially fraudulent to determine if payment is warranted, including the use of outside vendors to conduct 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
• Has frequent customer interaction of a complex nature, including taking statements, responding to document requests and handling complaints
• Conducts complex online data application searches, research, and evaluation
• Utilizes approved vendors for complex site inspections, including body shops, medical clinics, loss locations etc.
• Collaborates with retained and staff counsel to develop strategies for advancing the investigation
• Reviews investigations with fraud outcomes to validate whether denial is appropriate
• Works in conjunction with law enforcement, as needed, on complex matters to pursue criminal charges if warranted
• Updates files with investigation outcome, and when no fraud or insufficient evidence is found, returns file to market claims office for further handling and settlement
• Enters claim data information into multiple Special Investigation Unit systems
• Notifies appropriate state agencies, industry databases, and underwriting regarding fraud outcomes
• Makes claim decisions regarding complex investigations, and pursues restitution
• Utilizes applications/tools to analyze claim information and other data to reveal hidden patterns of activity across multiple claims
• Works with market claims office/claims service area to meet customer experience and goals
• Must be knowledgeable about state laws and regulations
• Controls expenses through vendor management

Litigation

• Manages singular claims in litigation
• Chooses defense counsel
• Establishes or reviews litigation plan and participates in developing litigation strategy

Other Projects and Responsibilities

• May participate in one or more complex special assignments
• May serve as a committee team lead for medium-sized projects or as a committee team member on large projects involving complex case work
• Manages vendor relationship and oversees vendor performance
• May serve as market claims office liaison
• Facilitates training on fraud awareness for market claims office and industry personnel
• Collaborates with multiple areas of responsibility
• Attends training as required by state law or internal compliance, to further investigation skills

Functional Skills:

• Ability to interact effectively, and coach others on interacting effectively, with internal or external customers and act with empathy
• 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 industry knowledge to discipline practices, including best practices, to support the business unit
• 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 ability to leverage learned technical skills in support of team objectives
• Applies broad negotiation and/or arbitration skills
• Applies broad conflict management and problem resolution skills in managing internal and external customer relationships
• Applies broad problem solving skills to continuously improve business outcomes
• Applies broad knowledge of training facilitation and coaching skills
• Ability to investigate, evaluate, negotiate and settle complex claims
• Provides broad individual decision making within authority limits
• Has and maintains all appropriate licenses and registrations for the role per state requirements

Education and Experience:

• 4 year Bachelors Degree (Preferred)

• 3 or more years of SIU experience (Preferred)
• 3 or more years of Bodily Injury claims experience (Preferred)
• Familiarity with provider based billing and practice issues
• In lieu of the above education requirements, an equivalent combination of education and experience may be considered.

This position will handle investigations in the state of Illinois, Wisconsin, Ohio and Indiana

Schedule:

This team works a schedule with a 4 day work week and 10 hour shifts.

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.

Compensation offered for this role is $59,250.00-$96,937.50 per year and is based on experience and qualifications.

The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug screen.

Good Hands. Greater Together. ℠

As a Fortune 100 company and industry leader, we provide a competitive salary – but that’s just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, you’ll have access to a wide variety of programs to help you balance your work and personal life -- including a generous paid time off policy. For a full description of Allstate’s benefits, visit https://www.allstate.jobs/benefits/

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Allstate generally does not sponsor individuals for employment-based visas for this position.

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