Investigator II Claims Specialist

State of Delaware; Delaware; On-site; USD 58,000 - 72,000; Full time

Job summary

The State of Delaware invites applications for an Investigator II to support the Paid Family and Medical Leave program under the Healthy Delaware Families Act. You will be the primary contact for claimants, ensuring efficient processing, fairness, and regulatory compliance.

Responsibilities include investigating issues, reviewing eligibility, maintaining detailed records, and identifying potential fraud. The role emphasizes customer service, organization, and the ability to handle a high-volume

Qualifications

• At least one year of experience conducting investigations and documenting findings.
• At least one year evaluating information to make recommendations on alleged or probable violations.
• At least one year providing clear, prompt and accurate information to respond to and resolve complaints.
• Six months in civil, criminal or administrative proceedings such as providing testimony before boards/commissions/authorities, preparing evidence/sworn statements, or managing and prioritizing cases.

Responsibilities

• Conduct investigations of alleged or probable violations or compliance issues by identifying, obtaining, verifying, and analyzing information.
• Collect, control, and evaluate evidence such as physical, financial, background, and other records and documents.
• Formulate questions and conduct interviews to obtain information and ascertain facts from witnesses and complainants.
• Interpret and ensure compliance with applicable laws, rules, regulations, standards, and procedures.
• Make judgments after evaluating all facts and recommend action to authorities; may take enforcement action as necessary.
• Use automated information systems and software to research and report on investigative data.
• Document details of all calls, emails, inquiries, and interviews during investigations.
• Prepare and submit investigative reports documenting findings and actions taken.

Skills

Investigation experience

Interviews

Compliance knowledge

Communication

Customer service

Tools

Automated systems

Reporting software

Job description

Summary Statement

This Investigator II role supports Delaware's Paid Family and Medical Leave insurance program established under the Healthy Delaware Families Act. You will serve as a primary point of contact for claimants, ensuring claims are processed efficiently, fairly, and in compliance with the Act and applicable regulations. Key responsibilities include investigating and resolving claim issues, discrepancies, and claimant concerns; maintaining detailed and accurate records; reviewing claims to verify eligibility; and identifying potential fraud.

Summary Statement

This Investigator II role supports Delaware's Paid Family and Medical Leave insurance program established under the Healthy Delaware Families Act. You will serve as a primary point of contact for claimants, ensuring claims are processed efficiently, fairly, and in compliance with the Act and applicable regulations. Key responsibilities include investigating and resolving claim issues, discrepancies, and claimant concerns; maintaining detailed and accurate records; reviewing claims to verify eligibility; and identifying potential fraud. Success in this role will involve customer service and organizational skills; the ability to manage a high-volume caseload; attention to detail to identify suspicious activity; proficiency with automated systems; and a commitment to equitable and consistent administration of the Delaware PFML program.

Essential Functions

• Conducts investigations of alleged or probable violations or compliance issues by identifying, obtaining, verifying, and analyzing relevant information or evidence.
• Collects, controls, and evaluates evidence such as physical, financial, background, and other records, documents and items.
• Formulates questions and conducts interviews to obtain information and ascertain facts from witnesses, complainants, victims or other parties.
• Interprets, explains and ensures compliance with applicable state and federal laws, rules, regulations, standards, policies, and procedures.
• Makes judgments after evaluating all available facts and recommends appropriate action to authorities, commissions, or technical supervisors, and may take enforcement action as necessary.
• Uses commercial and proprietary automated information systems, computer software, and the internet to research, document, verify and report on investigative/intelligence data and related information.
• Documents details of all calls, emails, inquiries, interviews, and other interactions during the investigation and may be assigned to respond to hotlines.
• Prepares and submits investigative reports that clearly and accurately document findings, supporting facts, and action taken.
• Testifies and presents evidence before boards, commissions, administrative bodies, or courts.
• Delivers excellent customer service to internal and external customers and the public in person, electronically, or by written communication.
• Communicates and interacts effectively with people across cultures, ranges of ability, genders, ethnicities, ages, and races.
• May conduct surveillance, undercover investigations, and on-site inspections on assigned cases; and may make arrests or obtain search warrants pertaining to an investigation.
• May make recommendations to subpoena information.

Job Requirements

• One year of experience in conducting investigations which may include conducting interviews to obtain confidential information, gathering evidence, and documenting findings.
• One year of experience in collecting, evaluating and analyzing relevant information to make recommendations on alleged or probable violations of state or federal laws, rules and regulations.
• One year of experience in providing clear, prompt and accurate information to respond to and resolve complaints.
• Six months' experience in civil, criminal or administrative proceedings such as providing testimony before boards/commissions/authorities, preparing evidence/sworn statements, or managing and prioritizing cases.

Conditions of Hire

Applicants must be legally authorized to work in the United States. The State of Delaware Executive Branch participates in the Federal E-Verify system where the State will provide the federal government with each new hires Form I-9 information to confirm that you are authorized to work in the U.S. For more information refer to our job seeker resources.

All new hires are required to report to the Statewide New Employee Orientation (SNEO) on their first day of employment. Sessions are held at designated locations in Kent or New Castle County.

Criminal background check: A satisfactory criminal background check is required as a condition of hire. The recruiting agency may require the applicant to pay for the criminal background check as part of the conditional offer of hire.

Benefits

To learn more about the comprehensive benefit package please visit our website at https://dhr.delaware.gov/benefits/

Selection Process

The application and supplemental questionnaire are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position. It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment, job title and job duties. For education and training, list name of educational provider, training course titles and summary of course content. Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements. Once you have submitted your application on-line, all future correspondence related to your application will be sent via email. Please keep your contact information current. You may also view all correspondence sent to you by the State of Delaware in the "My Applications" tab at StateJobs.Delaware.gov .

Accommodations

Accommodations are available for applicants with disabilities in all phases of the application and employment process.

Individuals who use TDD may request auxiliary aid or service by calling [phone] or by visiting delawarerelay.com .

If you need assistance with an accommodation under the Americans with Disabilities Act (ADA) or general applicant support, you may call [phone] or email [e-mail] .

The State of Delaware is an Equal Opportunity employer and values a diverse workforce. We strongly encourage and seek out a workforce representative of Delaware including race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression.