Healthcare SIU Investigator
Posted on May 4 Jacksonville, FL 389 views
You’ll do all this in an environment of excellence and the highest ethical standards – a place where values such as integrity, inclusive diversity and accountability are paramount. We empower every employee to lead, drive change and give back where they work and live. Our people are our greatest strength, and we work as one team in service of our customers and communities.
Everything we do at Allstate is driven by a shared purpose: to protect people from life’s uncertainties so they can realize their hopes and dreams. For more than 89 years we’ve thrived by staying a step ahead of whatever’s coming next – to give customers peace of mind no matter what changes they face. We acted with conviction to advocate for seat belts, air bags and graduated driving laws. We help give survivors of domestic violence a voice through financial empowerment. We’ve been an industry leader in pricing sophistication, telematics, digital photo claims and, more recently, device and identity protection. We are the Good Hands. We don’t follow the trends. We set them.
The Allstate Benefits Special Investigations Unit (SIU) is responsible for investigating potentially fraudulent Health claims as well as producers engaging in possible fraudulent activities.
The Investigator is responsible for conducting both Policy Holder and Agent/Producer investigations. The Investigator will appropriately document the investigation and refer cases of potential fraud to the appropriate regulatory agency. The Investigator may also create monthly reporting that documents the work performed by the SIU as well as the calculations supporting the estimated “savings” of claims denied and policies terminated.
The Investigator will also utilize various research and analytical tools, including but not limited to, Excel, queries, and various public records sources
- Thoroughly investigate and document all investigations and claims retained and provide that information in a timely manner to the Claims Department
- Responsible for the timely filing of cases to the applicable state Department of Insurance (DOI)
- Provides training to multiple Departments throughout the Company, including Claims and the Customer Care Center to promote the SIU function and provide instruction on how to identify fraud and respond to Customer inquiries
- Ensure that claims received on a daily basis into the SIU AWD work queue are reviewed in a timely fashion and a decision made as to whether or not the claim will be retained in the Unit
- Respond to Customer inquiries while claims are pending in SIU
- Make certain that SIU is compliant with state DOI requirements regarding the reporting of suspected fraud
- Ensure referrals are adequately documented required by the state
- Generate Management Reporting that documents the work condition of SIU and the calculated savings from denied claims and terminated policies
- Participate in investigations of Agents suspected of fraudulent activity
- 5-10 years of insurance experience
- Strong technical and analytical skills including the ability to perform data analysis
- Excellent oral and written communication skills
- Strong interrogatory skills
- Proficient in Microsoft Office, including Word and Excel
- Strong investigative skills
- Strong interpersonal skills
- Must be detail oriented and possess strong organizational skills
- Preferred but not required: 5+ years SIU experience
The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug screen.
Good Work. Good Life. Good Hands®.
As a Fortune 100 company and industry leader, we provide a competitive salary – but that’s just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, you’ll have access to a wide variety of programs to help you balance your work and personal life -- including a generous paid time off policy. For a full description of Allstate’s benefits, visit allstate.jobs/benefits/
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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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