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About the Role

Investigates and analyzes complex, multi-discipline coverage and claims referred to the special investigation unit (SIU) for potential fraud. Handles complex attorney represented and unrepresented claims and moderate to complex losses where suspicious activity has been identified.

Responsibilities

• Enters SIU claim data information into multiple SIU systems.
• 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.
• Conducts complex online data application searches, research, and evaluation.
• Conducts complex site inspections, including body shops, medical clinics, loss locations etc.
• 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.
• 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.
• Researches and responds to complex customer communications, concerns, conflicts or issues.
• Performs background searches, scene investigations, and clinic inspections.
• Takes recorded statements.
• Reviews and analyzes medical notes, bills, and property damage.
• Conducts witness interviews and social media searches.
• Conducts surveillance on property and/or creates scene reconstructions on some investigations.
• Reviews whether fraud can be substantiated and supports a lawsuit.
• Provides work guidance and direction to less senior employees.
• Provides mentoring and coaching to the team.

Requirements

• Must terminate all existing appointments prior to onboarding if holding an active insurance license and must not hold any outside appointments at any point during employment.
• Applicants seeking an adjuster role who also hold a resident producer license must formally surrender that license when instructed to by the licensing team.
• 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.
• Must have a dedicated, private workspace free from distractions, along with appropriate desk and seating.
• Reliable internet is required, with minimum speeds of 50 MB download and 5 MB upload.

Skills

• Documentations
• Law Enforcement
• Special Investigations

Location

• New York
• Bronx
• Manhattan
• Westchester

Work Type

• Field-based
• Location-specific

Experience Level

• Experienced

Salary/Compensations

• SIU Cons I: $60,000 - $87,400
• SIU Cons II: $62,100 - $92,700
• SIU Sr Cons I: $68,500- $104,100

Benefits

• Comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse.
• Monthly connectivity reimbursement to help offset internet costs for eligible remote workers.

About the Company

• National General is a part of The Allstate Corporation, offering innovative insurance solutions.
• 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.

Equal Opportunity

• 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.
• 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 Know Your Rights” 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.