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 :

About NYSIF :

NYSIF is the largest workers' compensation insurer in New York State and among the ten largest nationwide. NYSIF covers 2 million workers and insures 200,000 employers in New York State. NYSIF's mission is to guarantee the availability of workers' compensation, disability insurance and paid family leave at the lowest possible cost to New York employers while maintaining a solvent fund. Since its inception 110 years ago, NYSIF has fulfilled this mission by competing with other insurance carriers to ensure a fair marketplace while serving as a guaranteed source of coverage for employers that cannot secure coverage elsewhere. NYSIF strives to achieve the best health outcomes for injured workers and be an industry leader in price, quality, and service for New York employers.

NYSIF Commitment to Diversity, Equity, and Inclusion :

The New York State Insurance Fund (NYSIF) prioritizes and champions diversity, equity, and inclusion (DEI) throughout our agency. NYSIF provides equal opportunities to all employees and applicants for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability, veteran status, or any other protected category under federal, state, and local law. We believe that embracing our differences brings richness, new ideas and experiences to NYSIF, which energizes a creative and innovative work environment. We strive to foster a workplace where diverse individuals are able to participate fully in the decision-making process and have ample opportunity for advancement. We are committed to investing the necessary resources and attention to improving the engagement, retention, and promotion of the extraordinary talent we have.

Executive Order 31 :

Executive Order 31 commits New York State government to becoming a model employer for people with disabilities, increasing the participation of people with disabilities in state service and ensuring equal access to opportunities. NYSIF is proud to utilize best practices to recruit, hire, retain, and promote career advancement of individuals with disabilities. This includes special focus on current and prospective employees with the most significant disabilities, such as the use of supported employment, individual placement with support services, customized employment, the civil service sections 55 / b and 55 / c programs, internships, and job shadowing. If you are a person with a disability and wish to request that a reasonable accommodation, be provided for you to participate in a job interview, please send an email to NYSIF's Reasonable Accommodations mailbox at ra@nysif.com.

This position requires frequent travel, you are required to maintain a valid driver's license while employed in this position.