Job Description

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
• 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
• 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
• This role handles claims in New York and New England

Preferred Qualifications:

• Bachelor's Degree or equivalent preferred
• SIU experience preferred
• 3 years claims handling experience required
• PIP and MED PAY experience is a plus

Certificates, Licenses, Registrations:

• New England licenses in CT, MA and RI are a plus

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.

#LI-AC3

Skills
Analytical Thinking, Casualty Insurance, Communication, Customer Interactions, Customer Service, Evidence Gathering, Insurance Fraud Investigations, Negotiation, Researching, Special Investigations

Compensation
Compensation offered for this role is $56,500.00 - 99,962.50 annually and is based on experience and qualifications.
The candidate(s) offered this position will be required to submit to a background investigation.

Joining our team 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.

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

Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, 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.

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