Claims Fraud Investigator

About the role

Detect and investigate Workers' Compensation fraud as well as other related employee availability related matters. Conduct investigations through fieldwork, research, surveillance, interviews, social media, open-source methods, undercover methods and other means. Position located at 2 Broadway, New York, NY 10004. Hours are various; telework may be applicable. As an MTA NYC Transit employee, 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 per year or is designated as a policy maker. Candidates may be considered for the 55‑a Program; see https://www1.nyc.gov/site/dcas/employment/55-a-program.page for details.

Responsibilities

• Perform and/or monitor surveillance necessary to gather evidence, identify unknown subjects or issues, and confirm or refute information under review.
• Assist in the training and development of referral sources, including claim examiners and staff, to enhance awareness, increase detection, and develop new intelligence.
• Research investigative matters and conduct interviews with involved parties, witnesses, and subject matter experts to collect accurate and relevant information.
• Support counsel through testimony and hearing/trial preparation, providing case findings, documentation, ensure custody of evidence, and enhancement of counsel’s presentation.
• Prepare investigative reports documenting all investigative activity, findings, evidence, and recommendations in a clear and organized format.
• Build, maintain, and strengthen professional relationships through professional organizations with outside agencies, partner organizations, and internal stakeholders to facilitate information sharing and collaborative case development.
• Execute special assignments and undercover operations as directed, ensuring discretion, compliance with protocols, and adherence to safety procedures.
• 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.

Requirements

• Bachelor's Degree in Arts/Sciences (BA/BS) required in any field.
• 3 years of experience in claim investigations, claim examiner/handling, or law enforcement detective work.

Skills