Siu Field Investigator (Remote From South Florida)

Job Title/Position: SIU Field Investigator (Remote from South Florida)

• NOTE: We are not able to provide any relocation assistance for candidates that do not already live in the South Florida (Ft. Lauderdale, Miami) areas. If hired, you would have to relocate at your expense to that area.
• NOTE: Ideal candidate will have experience as an SIU Investigator in the past or come out of a Claims division doing investigations.

Job Summary:

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.

Key Responsibilities:

• Manages, researches, and resolves complex and occasionally highly complex customer communications, concerns, conflicts or issues
• 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
• Reviews investigations with fraud outcomes to validate whether denial is appropriate
• Makes claim decisions regarding complex and occasionally highly complex investigations, and pursues restitution
• Enters SIU claim data information into multiple SIU systems
• Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision making process
• Oversees file quality Investigative Consultant
• Manages vendor relationship and oversees vendor performance
• 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
• Updates files with investigation outcome, and when no fraud, or if insufficient evidence is found, returns file to MCO for further handling and settlement

Supervisory Responsibilities:

This job does have supervisory duties

Preferred Qualifications:

Education and Experience

• 3 or more years of related experience
• Bachelor’s Degree or equivalent experience

Certificates, Licenses, Registrations

• None

Functional Skills

• Applies advanced knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data
• Applies advanced negotiation and/or arbitration skills
• Ability to investigate, evaluate, negotiate and settle complex and occasionally highly complex claims
• Applies advanced knowledge of insurance policy, coverage, and regulation
• Applies advanced knowledge of training facilitation and coaching skills
• Applies advanced knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards
• Applies advanced knowledge of problem solving and preparation of complex reports for analysis

#Remote

National General prides itself on offering our employees a robust Total Rewards package which includes base salary. The base range offered for the role is: $52,500 - $80,000 and may vary based on internal equity, and job-related skills, knowledge and experience; among other factors. Other financial components may be added as part of the competitive compensation package, in addition to a full range of benefits, dependent on the level and position offered.

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.