Review Vacancy
TitleInvestigative Officer 1 (SIF)
Occupational CategoryOther Professional Careers
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $53826 to $68511 Annually
Minimum Qualifications An associate’s degree or higher in criminal justice or related field, or five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, or seven years of professional investigation experience involving economic or insurance related matters. Related fields include: law enforcement, police science, criminal justice administration, criminology, criminal investigation, police studies, public justice, forensic accounting, forensic psychology, forensic science, and economic crime management.
Duties Description Under the general direction of the Investigative Officer 2 (SIF), the Investigative Officer 1 (SIF) supervises extensive investigations of fraud, waste and abuse by claimants, policyholders and medical care providers throughout the state.
Duties include, but are not limited to:
• Gathers and analyzes critical documentary evidence from various department files, contracts, investigator reports, police reports, payroll records, business records, bank records, and policyholder books and reports.
• Utilizes strong investigative experience to handle a full range of investigative tasks, including the most complex and sensitive investigations which require a full understanding of workers’ compensation law.
• Personally supervises and/or conducts database searches into corporations, liens, address and property ownership, and gathers other such public and private intelligence information to support investigations.
• Utilizes investigative expertise and contacts within the legal/prosecutorial community to effectively investigate, gather and analyze critical documentary evidence to build a sound case. Reviews investigations, written reports and associated evidence to conclude sufficiency of evidence for presentation to a prosecutor for criminal actions or NYSIF Civil actions.
• Under the direction of the Investigative Officer 2 (SIF), uses their experience and knowledge of, and contacts with, prosecutorial officials to ensure the proper presentation of evidence and the full development of all potential criminal and civil actions. Investigative Officers 1 (SIF) may also directly ensure NYSIF’s investigations are receiving the proper attention from the prosecutors and provide assistance with the initiation and presentation of new cases, as well as the follow-up after convictions.
• Participates in NYSIF sponsored training to adapt investigative skills for the detection of insurance fraud.
• Provides fraud detection training and mentoring to Business Office staff to ensure optimal attention to potential signs or “Red Flags” of claims fraud, policy fraud and medical provider fraud. Interacts with all levels of staff and management at NYSIF in this regard.
• Reviews, analyzes and extracts material from claims, underwriting and hospital records to determine the validity of allegations.
• Interviews and obtains affidavits and testimonies from witnesses and subjects of investigations, including for example employers, co-workers, witnesses to accidents, lawyers, physicians, hospital administrators and insurance executives.
• Obtains documentary evidence concerning concealed employment and illicit activities including payroll records, receipts, contracts, and affidavits from employers.
• Employs foot, stationary, and vehicle surveillance techniques to gather and record evidence in various formats.
• Directs undercover surveillance at worksites, private homes, and businesses belonging to claimants, doctors, and/or policyholders utilizing the services of contractual investigators, as needed.
• Prepares narrative reports, as well as reviews and compiles staffs’ reports for submission to Executive Management.
• Maintains professional contact with Legal counsel, law enforcement authorities, sister state agencies and regulatory agencies.
• Collaborates with NYSIF attorneys on the preparation for trials, civil litigation and/or Workers’ Compensation Board hearings.
• Testifies at trials and other official proceedings, when necessary, and/or arranges for witness testimony and introduction of evidence at trial.
• May conduct internal employee background investigations.
• Prioritizes, assigns and coordinates the workload of support staff; providing training and advice to staff; and evaluating performance and quality of work.
Some positions may require additional credentials or a background check to verify your identity.