Lead Claims Fraud Investigator

Metropolitan Transportation Authority (MTA); New York (NY); On-site; USD 83,000 - 104,000; Full time

Job summary

Metropolitan Transportation Authority (MTA) is seeking a Supervising Claims Fraud Investigator to lead the unit in detecting and investigating Workers' Compensation fraud and related matters. The role oversees fieldwork, research, surveillance, interviews, social media and open-source methods.

You will supervise investigators, coordinate with counsel, and ensure investigations meet high standards while managing resources and workflows.

Qualifications

• BA/BS or equivalent in Arts/Sciences or related field.
• 7 years of insurance claim investigations or law enforcement detective work.
• 3 years of Insurance or Medical Fraud Investigation Experience.

Responsibilities

• 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 recognizing suspicious activity.
• Assist counsel in 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 and guide investigators.
• Assign matters and ensure necessary skillsets/resources are available.
• Complete high-level complex investigations.
• Performs other duties as assigned.
• Complies with all policies and standards.
• May work hours outside regular hours, as applicable.
• Observe work performed by contractors, as applicable.
• Review invoices and approve them if contractual standards are met.
• Address performance issues with contractors when possible.
• Escalate issues to other parties when needed.

Skills

Surveillance

Undercover operations

Medical terminology

Strong writing

Testifying

Social media

Education

BA/BS or equivalent

7 years investigations experience

3 years fraud investigation experience

Job description

Metropolitan Transportation Authority (MTA) is seeking a Supervising Claims Fraud Investigator to lead the unit in detecting and investigating Workers' Compensation fraud and related matters. The role oversees fieldwork, research, surveillance, interviews, social media and open-source methods.

You will supervise investigators, coordinate with counsel, and ensure investigations meet high standards while managing resources and workflows.