SENIOR FRAUD EXAMINER

State of New Hampshire; New Hampshire; Vor Ort; USD 51.000 - 70.000; Vollzeit

Benefits dieser Stelle

Health benefits

Retirement plan

Paid holidays

Zusammenfassung

State of New Hampshire Insurance Department seeks a Senior Fraud Examiner to lead high-level fraud investigations across multiple insurance lines. The role includes supervising examiners, preparing reports, and testifying as needed.

A bachelor's degree with substantial experience in accounting, auditing, or insurance regulation is required. Trainee status is available for candidates meeting the alternative education/experience criteria.

Qualifikationen

• Education/Experience: Bachelor's degree and 7 years of experience OR equivalent combination of 11 years of education and experience.
• License/Certification: Valid driver’s license or access to transportation.
• Trainee Option: 10+ years of relevant education/experience may be hired in trainee status.

Aufgaben

• Functions as the senior examiner on high-level complex impact fraud cases and investigations.
• Assigns tasks and reviews work product of other examiners or investigators.
• Teaches and provides on-the-job training to trainees and staff.
• Prepares examination reports and testifies at hearings and trials.

Ausbildung

Bachelor's degree + 7 years experience OR 11 years education/experience

Jobbeschreibung

State of New Hampshire Job Posting

Insurance Department

Lega Division, Fraud Unit

21 South Fruit Street, Suite 14, Concord, NH 03301

SENIOR FRAUD EXAMINER

Position #10958

$37.22/hour - $51.07/hour

This position offers a Trainee Status* at the following pay rate: $35.62 per hour

• Candidates hired at a Trainee Status must meet minimum qualifications within one (1) year of hire date.
• See total compensation information at the bottom of announcement.

The State of New Hampshire Insurance Department has a full-time vacancy for Senior Fraud Examiner.

SUMMARY

Implements and supervises fraud examinations of domestic and foreign property and casualty insurance companies, life, accident and health insurance companies, health plans, health maintenance organizations, insurance agencies, premium trust account examinations and examinations of other insurance and insurance related entities as well as other involved parties for suspected insurance related criminal violations.

YOUR EXPERIENCE COUNTS

Each additional year of approved formal education may be substituted for one year of required work experience and/or each additional year of approved work experience may be substituted for one year of required formal education.

MINIMUM QUALIFICATIONS

Education/Experience: Bachelor's degree and 7 years of experience OR equivalent combination of 11 years of education and experience after completion of high school. Education and experience must be in accounting, auditing, business administration, insurance management , insurance regulation, or law enforcement with at least 2 years in insurance company examinations, insurance market conduct examinations, insurance fraud examinations and/or insurance fraud investigative work, insurance department rate, insurance policy, insurance contract or consumer protection regulation, insurance underwriting, insurance loss adjustment or a related field.

License/Certification: Valid driver’s license or access to transportation

Other Requirements: None

Trainee Option: Candidates with an equivalent combination of 10+ years of relevant education and experience after completion of high school, including 1 + years of experience in insurance company examinations, insurance market conduct examinations, insurance fraud examinations and/or insurance fraud investigative work, insurance department rate, insurance policy, insurance contract or consumer protection regulation, insurance underwriting, insurance loss adjustment, or a related field may be considered and hired in ‘trainee status’ for this position.

PREFERRED QUALIFICATIONS

• Designation as a Certified Insurance Fraud Investigator or Certified Fraud Examiner
• Thorough knowledge of the insurance laws and regulations of the State of New Hampshire.
• Thorough knowledge of accounting and market conduct principles and practices as used in the business of insurance.
• Working knowledge of office methods, procedures and equipment.
• Ability to establish and maintain an effective working relationship with other employees, insurance company officials, other US and international regulators and the public.
• Ability to develop administrative and statistical reports with evidence and recommendations.
• Willingness to spend periods of time out-of-state and traveling throughout the day.

AFTER-HIRE REQUIREMENTS

None

DISCLAIMERS

The supplemental job description lists the essential functions of the position and is not intended to include every job duty and responsibility specific to the position. An employee may be required to perform other related duties not listed on the supplemental job description provided that such duties are characteristic of that job title.

When applicable, the work of an employee in trainee status in this position shall be overseen by a fully qualified individual. An employee in trainee status shall meet the minimum qualifications within the period of time specified on the SJD, not to exceed one year of being hired into this position.

RESPONSIBILITIES

Functions as the senior examiner on high-level complex impact fraud cases, conducting fraud examinations or investigations, as assigned.

Assigns tasks and reviews work product of other examiners or investigators assisting in the examination or investigation of insurance fraud by insurance companies, insurance licensees, medical providers, billing companies, extended warranty companies/contractors, uninsured businesses, and others. Prepares reports for review by General Counsel and participates in redrafting reports as needed.

Provides technical expertise in the examination or investigation which requires knowledge in the areas of compliance with New Hampshire criminal and insurance statutes, department regulations, electronic data processing, internal controls, rating, underwriting, claims review, sales practices, marketing, advertising, provider billing practices, medical coding, fiduciary responsibilities and other areas of examination as needed to insure the integrity and quality of the examination or investigation.

As directed by the General Counsel, exercises technical supervision over junior examiners or investigative staff to allocate work assignments according to their individual levels of experience and expertise, and reviews the individual work papers of the staff on an ongoing basis during the examination or investigation, to ensure that they are technically correct from an legal standpoint and prepared in accordance that satisfies the objectives of the overall examination or investigation plan.

Teaches and provides on-the-job training to trainees, staff and other examiners to develop their knowledge of the principles of insurance, insurance company operations, analysis, investigations, financial analysis and examination skills.

Prepares an examination report or other required reports to document findings, recommendations and conclusions of the examination or investigation, with appropriate references that cite violations of insurance and/or criminal laws, and insurance regulations and bulletins.

Testifies at hearings and trials conducted by the insurance department, the Fraud Attorney or other prosecutor to present, explain and defend findings and recommendations. Participates in preparing enforcement and regulatory actions as needed.

Serves as a liaison between the insurance department and senior company management, chief executive officer and chief legal counsel about procedures that must be adopted to comply with New Hampshire Insurance Department policy and/or regulations, to correct examination or investigative findings and to satisfy recommendations.

Monitors progress, resolves questions or problems, and provides additional direction where deemed warranted by the work already performed and inform General Counsel and other staff of current examination developments or open investigations.

Functions so that the examination or investigation is conducted in a fair and professional manner, observes professional standards such as maintenance of independence, professional judgment and discretion, to respect the confidentiality and proprietary aspects of the information received and developed during the course of the examination or investigation.

For position-related questions, please contact Brian Caldwell, Insurance Fraud Director, at [e-mail].

For application-related questions, please contact Katrina Gagne, Human Resources Technician, at [e-mail].

• TOTAL COMPENSATION INFORMATION

The State of NH total compensation package features an outstanding set of employee benefits, including:

HMO or POS Medical and Prescription Drug Benefits:

The actual value of State-paid health benefits and the amount of employee health benefit contributions may vary depending on the type of plan selected and the bargaining unit with which a position is associated.

See this link for details on State-paid health benefits:
https://www.das.nh.gov/hr/benefits.aspx

Value of State's share of Employee's Retirement: 12.87% of pay

Other Benefits

• Dental Plan at minimal cost for employees and their families ($500-$1800 value)
• Flexible Spending healthcare and childcare reimbursement accounts
• State defined benefit retirement plan and Deferred Compensation 457(b) plan
• Work/life balance flexible schedules, paid holidays and generous leave plan
• $50,000 state-paid life insurance plus additional low-cost group life insurance
• Incentive-based Wellness Program (ability to earn up to $500)

Total Compensation Statement Worksheet:
https://www.das.nh.gov/jobsearch/compensation-calculator.aspx

Want the specifics? Explore the Benefits of State Employment on our website:
https://www.das.nh.gov/hr/documents/BenefitBrochure.pdf

https://www.das.nh.gov/hr/index.aspx

EOE

TDD Access: Relay NH 1-800-735-2964