Suzie Pierce
Sellersburg,IN
Summary
Collaborative Investigator identifies links between cases. Adept at analyzing and uncovering trends in complex data. Highly skilled in organized insurance fraud.
Overview
29
29
years of professional experience
1
1
Certification
Work History
SIU Investigator Consultant II
Allstate Insurance Co
05.2015 - Current
- Reviews investigations with fraud outcomes to validate whether denial is appropriate
- Conducts complex site inspections, including , medical clinics, loss locations etc.
- Utilized internal and external databases, claims and policy systems, and open-source intelligence information to build cases and prepared them for presentation to internal leadership, claims partners, and external agencies (law enforcement, National Insurance Crime Bureau, Department of Insurance)
- Validates information provided and obtained through investigation is true and accurate and follows up on all possible leads
- Enters SIU claim data information into multiple SIU systems
- Updates files with investigation outcome, and when no fraud or insufficient evidence is found, returns file to MCO for further handling and settlement
- Conducts thorough investigations of complex that are potentially fraudulent to determine if payment is warranted, including scene investigations and surveillance as needed
- Utilizes analytic tools or SIU field intelligence to identify complex claims for investigation and/or for support in evidence of fraud and damages
- Summarizes documents and enters into claim system notes, documenting claim file with notes, evaluations and decision-making process
- Researches and responds to complex customer communications, concerns, conflicts or issues
Represented Bodily Injury Adjuster
Allstate Insurance Co
10.2014 - 05.2015
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Examined claims forms and interpret policies and determine coverage
- Evaluate and negotiate claims settlements with customers, vendors, third party carriers and claimants, in accordance with all legal and business standard methodologies.
- Obtain recorded statement and interviews
- Examined claims forms and other records to determine insurance coverage.
Unrepresented Bodily Injury Adjuster
Allstate Insurance Co
09.2008 - 10.2014
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Prepared summaries of damage, payments, and policy coverage.
- Negotiated one on one with claimants for bodily injury claims.
Auto Total Loss Adjuster
Allstate Insurance Co
08.2003 - 08.2008
- Negotiate settlements with claimants and insureds
- Examined photographs and surveillance and any other documents relating to claims.
- Issued payouts to claimants and Insureds.
- Investigate Stolen vehicle claim
- Work with outside vendor to facilitate recovery efforts of salvage vehicles.
Senior Staff Claim Associate
Allstate Insurance Co
12.1995 - 08.2008
- Managing and Directing workflow disbursement for 16 Auto Field Technicians
- Processing field data
- Coordinating time off for Unit
- Producing production report on weekly basis
- Following up on pending assignments
Education
Bachelor of Science - Justice Administration
University of Louisville
Louisville, KY05.2003
Skills
- Policy Interpretation
- Interviewing witnesses
- Employee training and development
- Holistic claim handling experience
- Legal Compliance
- Insurance fraud
- Anti-fraud regulation compliance
Affiliations
- International Association of Special Investigation Units,
Certification
SCLA
Timeline
SIU Investigator Consultant II
Allstate Insurance Co
05.2015 - Current
Represented Bodily Injury Adjuster
Allstate Insurance Co
10.2014 - 05.2015
Unrepresented Bodily Injury Adjuster
Allstate Insurance Co
09.2008 - 10.2014
Auto Total Loss Adjuster
Allstate Insurance Co
08.2003 - 08.2008
Senior Staff Claim Associate
Allstate Insurance Co
12.1995 - 08.2008
Bachelor of Science - Justice Administration
University of Louisville
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