Chief of Investigations
The Chief of Investigations Duties include, but are not limited to, the following:
o Identifies methods to detect insurance fraud and abuse at the earliest moment and mitigate the loss to the Fund. o In conjunction with the Director and the Assistant Director, develops and oversees the administration of fraud training and educational programs for the Division, the Fund, policyholders, prosecutorial agencies, and related organizations. The Chief ensures that Fund employees at all levels are thoroughly and effectively trained in the detection of fraud; at times, may personally conduct training sessions. o Reviews the policy and procedures of the Fund to identify and recommend improvements that would protect the integrity of the funds paid to claimants, and the premiums charged to policyholders. o The Supervisory Investigators of the Claims, Provider and Premium Fraud will report directly to the Chief of Investigations. The Chief of Investigations will work together with the head of each of the units to identify and investigate fraud against the fund. The Chief of Investigations will also work in collaboration with the Data Analytics Unit to develop proactive initiatives to prevent and detect fraud. Supervises the Divisions field investigative efforts. o Acts as liaison with other local, state and federal high-level insurance fraud officials, as well as private sector leaders and organizations to identify, investigate and assist in prosecution of healthcare fraud. Meets with prosecutors regarding case referrals and ongoing prosecutions as well as high level fraud investigative and law enforcement officials to discuss topics relevant to compensation fraud prevention. o Works in conjunction with other state and federal fraud investigative and law enforcement organizations to develop shared resources to detect and prevent fraud. o Administers and reviews performance evaluations, probationary reports and counseling memoranda; supervises staff in the unit, provides staff with performance and disciplinary recommendations as needed. o Monitors potential problem areas to limit vulnerability; addresses areas of deficiency and proposes and ensures implementation of remedial action. o Handles matters of a confidential and/or sensitive nature received from the Director of Confidential Investigations, as needed. o Studies and reviews existing policies and procedures on topics which include but are not limited to, investigative techniques, interview skills, surveillance, and security, to formulate recommendations for improvement. Further, reviews existing work and operational practices to ensure compliance with policies procedures. o Maintains membership in pertinent fraud investigative organizations to keep abreast of trends and potential legislation which may impact the operations of the Division.
Job Function
The Chief of Investigations Duties include, but are not limited to, the following:
o Identifies methods to detect insurance fraud and abuse at the earliest moment and mitigate the loss to the Fund. o In conjunction with the Director and the Assistant Director, develops and oversees the administration of fraud training and educational programs for the Division, the Fund, policyholders, prosecutorial agencies, and related organizations. The Chief ensures that Fund employees at all levels are thoroughly and effectively trained in the detection of fraud; at times, may personally conduct training sessions. o Reviews the policy and procedures of the Fund to identify and recommend improvements that would protect the integrity of the funds paid to claimants, and the premiums charged to policyholders. o The Supervisory Investigators of the Claims, Provider and Premium Fraud will report directly to the Chief of Investigations. The Chief of Investigations will work together with the head of each of the units to identify and investigate fraud against the fund. The Chief of Investigations will also work in collaboration with the Data Analytics Unit to develop proactive initiatives to prevent and detect fraud. Supervises the Divisions field investigative efforts. o Acts as liaison with other local, state and federal high-level insurance fraud officials, as well as private sector leaders and organizations to identify, investigate and assist in prosecution of healthcare fraud. Meets with prosecutors regarding case referrals and ongoing prosecutions as well as high level fraud investigative and law enforcement officials to discuss topics relevant to compensation fraud prevention. o Works in conjunction with other state and federal fraud investigative and law enforcement organizations to develop shared resources to detect and prevent fraud. o Administers and reviews performance evaluations, probationary reports and counseling memoranda; supervises staff in the unit, provides staff with performance and disciplinary recommendations as needed. o Monitors potential problem areas to limit vulnerability; addresses areas of deficiency and proposes and ensures implementation of remedial action. o Handles matters of a confidential and/or sensitive nature received from the Director of Confidential Investigations, as needed. o Studies and reviews existing policies and procedures on topics which include but are not limited to, investigative techniques, interview skills, surveillance, and security, to formulate recommendations for improvement. Further, reviews existing work and operational practices to ensure compliance with policies procedures. o Maintains membership in pertinent fraud investigative organizations to keep abreast of trends and potential legislation which may impact the operations of the Division.
Salary Range:
From $116686 to $147256 Annually
Minimum Qualification
Basic
Qualifications:
o Bachelor's degree and 9 years professional investigation experience in economic or insurance related matters, at least 3 years of which were at a supervisory or managerial level. Preferred
Qualifications:
o Law Enforcement or Insurance Fraud Investigative experience.Estimated Salary: $20 to $28 per hour based on qualifications.
o Identifies methods to detect insurance fraud and abuse at the earliest moment and mitigate the loss to the Fund. o In conjunction with the Director and the Assistant Director, develops and oversees the administration of fraud training and educational programs for the Division, the Fund, policyholders, prosecutorial agencies, and related organizations. The Chief ensures that Fund employees at all levels are thoroughly and effectively trained in the detection of fraud; at times, may personally conduct training sessions. o Reviews the policy and procedures of the Fund to identify and recommend improvements that would protect the integrity of the funds paid to claimants, and the premiums charged to policyholders. o The Supervisory Investigators of the Claims, Provider and Premium Fraud will report directly to the Chief of Investigations. The Chief of Investigations will work together with the head of each of the units to identify and investigate fraud against the fund. The Chief of Investigations will also work in collaboration with the Data Analytics Unit to develop proactive initiatives to prevent and detect fraud. Supervises the Divisions field investigative efforts. o Acts as liaison with other local, state and federal high-level insurance fraud officials, as well as private sector leaders and organizations to identify, investigate and assist in prosecution of healthcare fraud. Meets with prosecutors regarding case referrals and ongoing prosecutions as well as high level fraud investigative and law enforcement officials to discuss topics relevant to compensation fraud prevention. o Works in conjunction with other state and federal fraud investigative and law enforcement organizations to develop shared resources to detect and prevent fraud. o Administers and reviews performance evaluations, probationary reports and counseling memoranda; supervises staff in the unit, provides staff with performance and disciplinary recommendations as needed. o Monitors potential problem areas to limit vulnerability; addresses areas of deficiency and proposes and ensures implementation of remedial action. o Handles matters of a confidential and/or sensitive nature received from the Director of Confidential Investigations, as needed. o Studies and reviews existing policies and procedures on topics which include but are not limited to, investigative techniques, interview skills, surveillance, and security, to formulate recommendations for improvement. Further, reviews existing work and operational practices to ensure compliance with policies procedures. o Maintains membership in pertinent fraud investigative organizations to keep abreast of trends and potential legislation which may impact the operations of the Division.
Job Function
The Chief of Investigations Duties include, but are not limited to, the following:
o Identifies methods to detect insurance fraud and abuse at the earliest moment and mitigate the loss to the Fund. o In conjunction with the Director and the Assistant Director, develops and oversees the administration of fraud training and educational programs for the Division, the Fund, policyholders, prosecutorial agencies, and related organizations. The Chief ensures that Fund employees at all levels are thoroughly and effectively trained in the detection of fraud; at times, may personally conduct training sessions. o Reviews the policy and procedures of the Fund to identify and recommend improvements that would protect the integrity of the funds paid to claimants, and the premiums charged to policyholders. o The Supervisory Investigators of the Claims, Provider and Premium Fraud will report directly to the Chief of Investigations. The Chief of Investigations will work together with the head of each of the units to identify and investigate fraud against the fund. The Chief of Investigations will also work in collaboration with the Data Analytics Unit to develop proactive initiatives to prevent and detect fraud. Supervises the Divisions field investigative efforts. o Acts as liaison with other local, state and federal high-level insurance fraud officials, as well as private sector leaders and organizations to identify, investigate and assist in prosecution of healthcare fraud. Meets with prosecutors regarding case referrals and ongoing prosecutions as well as high level fraud investigative and law enforcement officials to discuss topics relevant to compensation fraud prevention. o Works in conjunction with other state and federal fraud investigative and law enforcement organizations to develop shared resources to detect and prevent fraud. o Administers and reviews performance evaluations, probationary reports and counseling memoranda; supervises staff in the unit, provides staff with performance and disciplinary recommendations as needed. o Monitors potential problem areas to limit vulnerability; addresses areas of deficiency and proposes and ensures implementation of remedial action. o Handles matters of a confidential and/or sensitive nature received from the Director of Confidential Investigations, as needed. o Studies and reviews existing policies and procedures on topics which include but are not limited to, investigative techniques, interview skills, surveillance, and security, to formulate recommendations for improvement. Further, reviews existing work and operational practices to ensure compliance with policies procedures. o Maintains membership in pertinent fraud investigative organizations to keep abreast of trends and potential legislation which may impact the operations of the Division.
Salary Range:
From $116686 to $147256 Annually
Minimum Qualification
Basic
Qualifications:
o Bachelor's degree and 9 years professional investigation experience in economic or insurance related matters, at least 3 years of which were at a supervisory or managerial level. Preferred
Qualifications:
o Law Enforcement or Insurance Fraud Investigative experience.Estimated Salary: $20 to $28 per hour based on qualifications.
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