Claims Fraud Investigator

MABSTOA; United States; On-site; USD 72,000 - 90,000; Full time

Job summary

MABSTOA is seeking a Claims Fraud Investigator in New York City to detect and investigate workers’ compensation fraud and related matters. You will conduct fieldwork, surveillance, interviews, and open-source research, and support counsel with testimony and trial preparation.

Qualified candidates have a BA/BS and at least three years in claim investigations, law enforcement, or similar detective work. The role is based at 2 Broadway, NY, with varied hours and potential telework where applicable.

Qualifications

• Knowledge of insurance claims practices and procedures.
• Experience using social media to further investigations.
• Surveillance and undercover investigation experience.
• Experience preparing investigative reports.
• Knowledge of medical claims and occupational injury.
• Experience testifying in multiple forums.

Responsibilities

• Perform surveillance to gather evidence and verify information.
• Assist in training referral sources, including claim examiners.
• Research investigations and interview involved parties to collect information.
• Support counsel through testimony and trial preparation, documenting findings and ensuring custody of evidence.
• Prepare investigative reports documenting activity, findings, evidence, and recommendations.
• Build relationships with outside agencies and internal stakeholders for information sharing.
• Execute special assignments and undercover operations following protocols.
• Performs other duties as assigned.
• Complies with policies and standards.
• May work hours outside regular hours.
• Observe contractors and review invoices as applicable.
• Escalates issues to other parties when needed.

Skills

Insurance claims knowledge

Social media investigations

Surveillance & undercover

Investigative reporting

Medical claims knowledge

Testifying experience

Education

BA/BS degree

Job description

Description

Position at MABSTOA

JOB INFORMATION:

|————————————|—————————————-|
| Title: | Claims Fraud Investigator |
| Authority: | NYCT |
| Department: | Operations Planning |
| Division/Unit: | Office of Chief Administrative Officer |
| Location: | 2 Broadway, New York, NY 10004 |
| Hours: | Various |
| Telework (if Applicable): | |
| Reporting Manager (if Applicable): | |
| Deadline (if Applicable): | |
| | |
| CompensationAuthority – Union | |
| Claims Fraud Investigator | $72,206 – $90,257 |

POSITON SUMMARY:
Detect and investigate Workers’ Compensation fraud as well as other related employee availability related matters. Conduct investigations through fieldwork, research, surveillance, interviews, social media, open-source methods, undercover methods and other means.
RESPONSIBILITIES:

• Perform and/or monitor surveillance necessary to gather evidence, identify unknown subjects or issues, and confirm or refute information under review.

• Assist in the training and development of referral sources, including claim examiners and staff, to enhance awareness, increase detection, and develop new intelligence.

• Research investigative matters and conduct interviews with involved parties, witnesses, and subject matter experts to collect accurate and relevant information.

• Support counsel through testimony and hearing/trial preparation, providing case findings, documentation, ensure custody of evidence, and enhancement of counsel’s presentation.

• Prepare investigative reports documenting all investigative activity, , findings, evidence, and recommendations in a clear and organized format.

• Build, maintain, and strengthen professional relationships through professional organizations with outside agencies, partner organizations, and internal stakeholders to facilitate information sharing and collaborative case development.

• Execute special assignments and undercover operations as directed, ensuring discretion, compliance with protocols, and adherence to safety procedures.

• Performs other duties as assigned

• Complies with all policies and standards

• May be required to work hours outside regular work hours, as applicable

• Observes the work performed by contractors, as applicable

• Reviews invoices and approves them if the work has contractual standards, as applicable

• Addresses performance issues with the contractor when possible, as applicable

• Escalates issues to other parties when needed, as applicable

EDUCATION AND EXPERIENCE:

1. Bachelors Degree in Arts/Sciences (BA/BS) Required in any field

2. 3 years, Experience in claim investigations, claim examiner/handling or law enforcement detective

DESIRED SKILLS:

• Knowledge of insurance claims practices and procedures

• Experience using social media to further investigations

• Surveillance and undercover investigation experience

• Experience preparing investigative reports

• Knowledge of medical claims and occupational injury

• Experience testifying in multiple forums

SELECTION METHOD
Based on evaluation of education, skills, experience, interview, and written assessment.
All selected candidates will be subject to a full background investigation that includes employment and education. Discrepancies may lead to dismissal.
OTHER INFORMATION
Appointment may be at a comparable level to current level of selected candidate. (If necessary)
As an employee of MTA NYC Transit, you may be required to complete an annual financial disclosure statement with the state of New York, if your position earns more than $101,379 (this is subject to change) per year or if the position is designated as a policy maker.
For 55-a eligible titles: Candidates selected for this position may be placed in a competitive or non-competitive class position based on their qualifications. Qualified candidates who are placed in a competitive class position are eligible for the 55-a Program. Please indicate in your cover letter and in the upper right corner of your resume that you would like to be considered for the position under the 55-a Program. For detailed information regarding the 55-a Program, please visit the following link https://www1.nyc.gov/site/dcas/employment/55-a-program.page
ADDITIONAL INFORMATION
Final salary is determined experience, skillset, and alignment with compensation practices. The posted range reflects expected compensation and may be updated as market or business needs evolve.
To be eligible for consideration for a new role, current MTA employees must complete at least one year of service in their current role prior to applying. Additionally, eligibility to interview is contingent upon maintaining a satisfactory record of job performance, attendance, and disciplinary conduct. Pursuant to the New York State Public Officers Law & the MTA Code of Ethics, all employees who hold a policymaking position must file an Annual Statement of Financial Disclosure (FDS) with the NYS Commission on Ethics and Lobbying in Government (the “Commission”).

EQUAL EMPLOYMENT OPPORTUNITY
MTA and its subsidiary and affiliated agencies are Equal Opportunity Employers, including with respect to veteran status and individuals with disabilities.
The MTA encourages qualified applicants from diverse backgrounds, experiences, and abilities, including military service members, to apply.