Supervising 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) 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

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 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

Skills

Medical terminology

Social media

Surveillance systems

Testifying

Undercover operations

Strong writing

Education

BA/BS or equivalent

7 years of insurance claim investigations or law enforcement detective work

3 years of Insurance or Medial Fraud Investigation Experience

Job description

Title

Supervising Claims Fraud Investigator

Authority

NYCT

Department

Office of the President

Division/Unit

Office of the CAO

Location

130 Livingston St, Brooklyn, NY 11201

Hours

9:00 AM – 5:00 PM

Telework (if Applicable)

Reporting Manager (if Applicable)

Deadline (if Applicable)

Compensation, Union: NYCT-MANAGERIAL CAREER & SALRY

Salary

$83,036 – $103,796 (Grade 003)

Positon Summary

Lead special investigations unit in the detection and investigation of Workers' Compensation fraud as well as other related employee availability related matters. Oversee investigations including the supervision and quality control of fieldwork, research, surveillance, interviews, social media, open-source methods, undercover methods and other means.

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 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

Education And Experience

• 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

Desired Skills

• Knowledge of medical terminology, social media and occupational injury
• Experience with surveillance and secuirty camera systems
• Experience testifying
• Undercover operations
• Strong writing skills

SELECTION METHOD

Based on evaluation of education, skills, experience, interview, and written assessment.

All selected candidates will be subject to a full background investigation that includes employment and education. Discrepancies may lead to dismissal.

Other Information

Appointment may be at a comparable level to current level of selected candidate. (If necessary)

As an employee of MTA NYC Transit, you may be required to complete an annual financial disclosure statement with the state of New York, if your position earns more than $101,379 (this is subject to change) per year or if the position is designated as a policy maker.

For 55-a eligible titles: Candidates selected for this position may be placed in a competitive or non-competitive class position based on their qualifications. Qualified candidates who are placed in a competitive class position are eligible for the 55-a Program. Please indicate in your cover letter and in the upper right corner of your resume that you would like to be considered for the position under the 55-a Program. For detailed information regarding the 55-a Program, please visit the following link https://www1.nyc.gov/site/dcas/employment/55-a-program.page

TA APPLICANTS MUST BE IN A PERMANENT CIVIL SERVICE STATUS IN THE TITLE(S). IF YOU ARE ON AN ESTABLISHED LIST, YOUR LIST NUMBER MUST BE REACHABLE TO BE CONSIDERED FOR APPOINTMENT. The Metropolitan Transportation Authority is North America's largest transportation network, serving a population of 15.3 million people across a 5,000-square-mile travel area surrounding New York City, Long Island, southeastern New York State, and Connecticut. The MTA network comprises the nation’s largest bus fleet and more subway and commuter rail cars than all other U.S. transit systems combined. MTA strives to provide a safe and reliable commute, excellent customer service, and rewarding opportunities.

Additional Information

Final salary is determined experience, skillset, and alignment with compensation practices. The posted range reflects expected compensation and may be updated as market or business needs evolve.

To be eligible for consideration for a new role, current MTA employees must complete at least one year of service in their current role prior to applying. Additionally, eligibility to interview is contingent upon maintaining a satisfactory record of job performance, attendance, and disciplinary conduct. Pursuant to the New York State Public Officers Law & the MTA Code of Ethics, all employees who hold a policymaking position must file an Annual Statement of Financial Disclosure (FDS) with the NYS Commission on Ethics and Lobbying in Government (the “Commission”).

EQUAL EMPLOYMENT OPPORTUNITY

MTA and its subsidiary and affiliated agencies are Equal Opportunity Employers, including with respect to veteran status and individuals with disabilities.

The MTA encourages qualified applicants from diverse backgrounds, experiences, and abilities, including military service members, to apply.