Claims Integrity & Compliance Lead (Workers' Comp)

City of New York; New York (NY); On-site; USD 68,000 - 99,000; Full time

Job summary

The City of New York seeks an Administrative Investigator to lead the Claims Integrity & Compliance function. You will develop and oversee a comprehensive program to detect and prevent fraud, analyze claims data, and coordinate investigations with oversight bodies.

Responsibilities include investigations into suspected fraud, training delivery, and improving regulatory compliance across the department. NYC residency is often required for appointment.

Qualifications

• Minimum qualifications describe experience in investigations to identify fraud or criminal activity, or to verify qualifications of persons for employment/licensure.
• Prefer experience in fraud prevention, risk management, insurance claims, or related field.
• Strong analytic, investigative, and communications skills are preferred.

Responsibilities

• Develop, implement, and oversee a comprehensive claims integrity and compliance program.
• Analyze broad claims data to identify trends and anomalies; conduct targeted investigations.
• Design proactive strategies to mitigate risk and ensure program integrity.
• Deliver internal and external fraud prevention trainings; coordinate investigations with oversight entities.
• Manage resources to validate entitlement to workers’ compensation benefits; improve operational efficiency and compliance.”],
• CoT_job_summary_short":"COMPANY NAME: City of New York\nKEY POINTS: Claims integrity program, fraud detection, investigations, staff training" ,
• job_summary_short":"<p>The City of New York seeks an Administrative Investigator to lead the Claims Integrity & Compliance function. You will develop and oversee a comprehensive program to detect and prevent fraud, analyze claims data, and coordinate investigations with oversight bodies.</p><p>Responsibilities include investigations into suspected fraud, training delivery, and improving regulatory compliance across the department. NYC residency is often required for appointment.</p>"
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• location_type":"on site
• remote_scope":null,
• perks":[],"stated_min":68214,"stated_max":99000,"stated_absolute":null,
• salary_estimation_cot":"Administrative Investigator in New York City: market rate is $68,214–$99,000 gross annually.",
• estimated_low":68214,
• estimated_medium":83607,
• estimated_high":99000,
• currency":"USD","frequency":"yearly","bonus":null,
• tax":"gross","application_email":null,
• job_end_date":null,
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• /

Skills

Investigations

Fraud prevention

Risk management

Analytical ability

Communication

Education

Bachelor's degree

Associate degree / 60 credits

High school diploma or equivalent

Job description

The City of New York seeks an Administrative Investigator to lead the Claims Integrity & Compliance function. You will develop and oversee a comprehensive program to detect and prevent fraud, analyze claims data, and coordinate investigations with oversight bodies.

Responsibilities include investigations into suspected fraud, training delivery, and improving regulatory compliance across the department. NYC residency is often required for appointment.