Investigator 1, Senior Investigative Officer

Investigator 1

The New York State Insurance Fund (NYSIF), Division of Confidential Investigations (DCI), is among the most active special investigations unit in the country, working with local, state, and federal authorities in the investigation, arrest and indictment of individuals and businesses suspected of fraud involving NYSIF. DCI's mission is to reduce the instances of insurance fraud and abuse against NYSIF, and to prevent and mitigate fraud. DCI is comprised of four separate teams : Claims Fraud, Provider Fraud, Policyholder Fraud and Data Analytics.

Responsibilities include, but are not limited to :

• Conduct a wide range of investigative activities, focusing on DCI's most complex, high-risk investigations, including developing confidential sources and participating in undercover operations to uncover facts that are otherwise difficult to obtain.
• In accordance with New York State Workers' Compensation Law and applicable NYS criminal and civil laws, these investigators will utilize their law enforcement experience to gather, analyze and report information to support fraud investigations.
• Assist with the prevention, detection, identification, elimination and exposing of criminal activity, misconduct, fraud, waste, abuse, corruption, and other improper behavior related to the NYS Workers' Compensation and applicable NYS Laws.
• Utilize familiarity with critical concepts such as compliance with discovery laws and practices, evidence collection, undercover operations and surveillance protocols, particularly for cases DCI refers for criminal prosecution.
• Review claims submitted by businesses and individuals to ensure accuracy of reported injuries or disabilities, and validity of supporting documentation and utilize them as a basis to conduct in-depth interviews, obtain critical facts and documentary evidence related to potential patterns of ongoing fraudulent or illegal activities.
• Prepare and serve subpoenas and other legal documents.
• Gather and analyze critical documentary evidence from various NYSIF departments, financial and governmental including contracts, private investigator reports, police reports, payroll records, business records, and policyholder books and reports to extract facts and evidence to determine the validity of allegations.
• Prepare clear and detailed written reports documenting all investigative activities, findings and outcomes.
• Use their experience in financial crimes investigations to conduct comprehensive reviews of workers' compensation and disability records in accordance with New York State Workers' Compensation Law and other applicable statutes. Examine financial records and employment histories to detect patterns indicative of fraud, misrepresentation, or other violations.
• Coordinate with legal and law enforcement personnel to present findings and support potential criminal, civil or administrative proceedings.
• Exercise discretion and critical judgment in identifying drawing law enforcement conclusions based on criminal law, civil law, regulatory guidelines and evidentiary standards.
• Utilize their experience to serve as fact or expert witness before grand and trial juries, by delivering clear testimony in proceedings, articulating investigative methods, evidentiary findings, and professional conclusions.
• Collaborate closely with existing prosecutors and law enforcement contacts, as well as make new ones.
• May perform the full range of supervisory responsibilities, as necessary.

Minimum Qualifications :

Preferred Qualifications :

Please note the following New York State Civil Service employment information :

Some positions may require additional credentials or a background check to verify your identity.