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 complex and occasionally 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 complex losses and claims involving extra-contractual liability, large fire and property 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 (3) conducting witness interviews and social media searches. The individual reviews whether fraud can be substantiated and supports a lawsuit.
** This is a field role with the SIU Fraud investigation department, conducting fraud investigations. Preferred candidate must be based around San Francisco, Oakland, San Jose, Sacramento or surrounding areas and service the greater commuting areas. Ideal candidate to have a combination of experience in investigation and insurance **
Key Responsibilities
- Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision making process
- Manages, researches, and resolves complex and occasionally highly complex customer communications, concerns, conflicts or issues
- Conducts complex and occasionally highly 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
- Conducts thorough investigations of complex and occasionally highly complex multi-discipline claims and ECL claims that are potentially fraudulent to determine if payment is warranted
- Utilizes analytic tools or SIU field intelligence to identify complex and occasionally highly complex claims for investigation and/or for support in the evidence of the fraud and damages
- Makes claim decisions regarding complex and occasionally highly complex investigations, and pursues restitution
- Enters SIU claim data information into multiple SIU systems
- Updates files with investigation outcome, and when no fraud, or if insufficient evidence is found, returns file to MCO for further handling and settlement
- Reviews investigations with fraud outcomes to validate whether denial is appropriate
Education
- 4 year Bachelors Degree (Preferred)
Experience
- 3 or more years of experience (Preferred)
Supervisory Responsibilities
- This job does not have supervisory duties.
Education & Experience (in lieu)
- In lieu of the above education requirements, an equivalent combination of education and experience may be considered.
Compensation
Compensation offered for this role is $62,800.00 - 97,050.00 annually and is based on experience and qualifications.
At National General, great things happen when our people work together. That’s why when you join our team, we make sure it 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.
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.
