Job Description

SIU Investigator Senior Consultant II - National General 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 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 large or significant losses and claims involving highly complex extra-contractual liability, large fire and property losses where 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; (4) and conducting witness interviews and social media searches. The individual reviews whether fraud can be substantiated and supports a lawsuit. At this level, the individual is expected to handle the most complex or specialized claims or claims involving significant dollar exposure or customers. 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 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 large or significant losses and claims involving highly complex extra-contractual liability, large fire and property losses where 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; (4) and conducting witness interviews and social media searches. The individual reviews whether fraud can be substantiated and supports a lawsuit. At this level, the individual is expected to handle the most complex or specialized claims or claims involving significant dollar exposure or customers. This is a field-based, location-specific role based in the Orlando metropolitan area. The ideal candidate will reside in one of the following counties: Orange, Osceola, Seminole, or Volusia. Key Responsibilities * Conducts thorough investigations of highly complex, multi-discipline claims and Excess Coverage Liability (ECL) claims that are potentially fraudulent to determine if payment is warranted

• Utilizes analytic tools or SIU field intelligence to identify 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
• Manages, researches, and resolves highly complex customer communications, concerns, conflicts or issues
• Makes claim decisions regarding highly complex investigations, and pursues restitution
• Reviews investigations with fraud outcomes to validate whether denial is appropriate
• Conducts highly complex site inspections, including body shops, medical clinics, loss locations etc.
• Conducts highly complex online data application searches, research, and evaluation
• Manages vendor relationship and oversees vendor performance
• Oversees file quality Investigative Consultant

Education * 4 year Bachelors Degree (Preferred) Experience * 3 or more years of experience (Preferred) Supervisory Responsibilities * This job does not have supervisory duties. Compensation National General Holdings Corp., a member of the Allstate family of companies, is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A- (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products. Companies & Partners Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident. Benefits National General Holdings Corp. is an Equal Opportunity (EO) employer - Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas. In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000. Helping all candidates find great careers is our goal. The information you provide here is secure and confidential. We are now directing you to the original job posting. Please apply directly for this job at the employer’s website. #J-18808-Ljbffr MedStar Health

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