Lead Claims Fraud Investigator

Metropolitan Transportation Authority (MTA); New York (NY); Sur place; USD 83 000 - 104 000; Plein temps

Résumé du poste

Metropolitan Transportation Authority (MTA) in New York seeks a Supervising Claims Fraud Investigator to lead the workers' compensation fraud investigations unit and related duties. You will supervise fieldwork, research, surveillance, and undercover activities while ensuring quality control and timely investigations.

The role requires strong writing, extensive fraud experience, and ability to collaborate with counsel, insurers, and law enforcement.

Qualifications

• Baccalaureate from an accredited college in Arts/Sciences (BA/BS) or an equivalent combination of education and experience.
• 7 years of insurance claim investigations or law enforcement detective work
• 3 years of Insurance or Medial Fraud Investigation Experience

Responsabilités

• Manage and develop flow of referrals from internal, external and Third Party Administrator sources.
• Assist in the training of investigators, claim examiners and related staff in the recognition of suspicious claim activity.
• Assist counsel in the preparation of matters for hearings, trials and labor arbitrations.
• Form and lead joint investigations with law enforcement agencies and insurance carriers.
• Manage inventory through review of investigative work product of assigned staff. Guide and counsel investigators on with their assignments.
• Assign matters and ensure the skillsets/resources necessary for success are available and utilized.
• Complete high level complex investigations.
• 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

Connaissances

Medical terminology

Social media

Surveillance systems

Testifying

Undercover operations

Strong writing

Formation

BA/BS or equivalent

7 years of insurance claim investigations or law enforcement detective work

3 years of Insurance or Medial Fraud Investigation Experience

Description du poste

Metropolitan Transportation Authority (MTA) in New York seeks a Supervising Claims Fraud Investigator to lead the workers' compensation fraud investigations unit and related duties. You will supervise fieldwork, research, surveillance, and undercover activities while ensuring quality control and timely investigations.

The role requires strong writing, extensive fraud experience, and ability to collaborate with counsel, insurers, and law enforcement.