Fraud Investigator: Claims & Surveillance

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

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.