National General
Location
Little Rock, AR | United States
Job description
*The ideal candidate will have previous experience as an SIU Investigator, or in law enforcement investigations. Prior Homeowners/Auto Claims Investigations is highly desirable*
The primary area of business demands in in the Little Rock, Arkansas area
Job Description:
This job is responsible for investigating and analyzing moderately complex and occasionally complex, multi-discipline coverage and claims that have been referred to the special investigation unit (SIU) for potential fraud. This role typically handles moderately complex and occasionally complex unrepresented and occasionally attorney represented claims and small losses (property).
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 analysis; and (4) conducting witness interviews and social media searches. The individual conducts surveillance on property and/or creates scene reconstructions on some investigations. T
he individual reviews whether fraud can be substantiated and supports a lawsuit. The individual provides work guidance and direction to less senior employees.
Key Responsibilities:
• Researches and responds to moderately complex and occasionally 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 moderately complex and occasionally complex claims for investigation and/or for support in the evidence of the fraud and damages
• Conducts thorough investigations of moderately complex and occasionally complex, multi-discipline claims 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
• Reviews investigations with fraud outcomes to validate whether denial is appropriate
• Updates files with investigation outcome, and when no fraud, or if 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 moderately complex and occasionally complex investigations, and pursues restitution
• Manages vendor relationship and oversees vendor performance
Supervisory Responsibilities:
This job does not have any supervisory duties.
Preferred Qualifications:
Education and Experience
• Bachelor's Degree or equivalent experience
• 3-5 or more years of related experience
Certificates, Licenses, Registrations
None
Functional Skills
• Applies general and occasionally broad knowledge of insurance policy, coverage, and regulation
• Applies general and occasionally broad knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards
• Applies general and occasionally broad knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data
• Applies general and occasionally broad knowledge of problem solving and preparation of reports for analysis
• Applies general and occasionally broad negotiation and/or arbitration skills
• Ability to investigate, evaluate, negotiate and settle moderately complex and occasionally complex claims
#LI-MP1
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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 - $85,000 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.
Job tags
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