TENTATIVE

Occ. Code 0370200

New York State Department of Civil Service

Classification Standard

BRIEF DESCRIPTION OF CLASS SERIES

            Insurance Field Investigators investigate fraud and collusion relating to Workers Compensation and Disability Benefits operations of the New York State Insurance Fund (SIF).  Incumbents investigate the operations and personnel of every department of SIF, and the activities of policyholders, doctors, lawyers, claimants, claimants representatives, and insurance brokers.

            These positions are classified only in the non-competitive jurisdictional class and are found only at SIF.

DISTINGUISHING CHARACTERISTICS

            INSURANCE FIELD INVESTIGATOR: journey level; investigates potentially fraudulent cases submitted to SIF by claimants, policyholders, and medical providers; investigates potentially fraudulent acts committed by SIF employees.

            SENIOR INSURANCE FIELD INVESTIGATOR: first supervisory level; drafts and serves subpoenas; administers background investigations; personally conducts sensitive field investigations.

            SUPERVISING INSURANCE FIELD INVESTIGATOR: second supervisory level; supervises Senior Insurance Field Investigators; plans, coordinates, and oversees educational seminars for SIF employees on fraud detection and prevention.

            PRINCIPAL INSURANCE FIELD INVESTIGATOR: manager; one-position class; oversees the day-to-day operations; monitors all investigations conducted Statewide; serves as the custodian of evidence for the Confidential Investigations Division.

ILLUSTRATIVE DUTIES

            INSURANCE FIELD INVESTIGATOR: under the direction of a Senior Insurance Field Investigator, reviews, analyzes, and extracts material from claims, underwriting, and hospital records to determine the validity of allegations; interviews and obtains affidavits and testimonies from employers, co-workers, witnesses, 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; reviews credit and collection records and investigates personnel to determine the completeness and quality of work performed; employs foot, stationary, and vehicle surveillance techniques to gather and record evidence in various formats; oversees the surveillance activities of contracted firms; determines the value of the case if found to be fraudulent; submits a detailed report of investigative findings; collaborates with SIF attorneys in preparation for the trial; and testifies at trial and/or arranges for witness testimony and the introduction of evidence at trial.

            SENIOR INSURANCE FIELD INVESTIGATOR: under the direction of a Supervising Insurance Field Investigator, oversees and coordinates the more difficult and sensitive field investigations; oversees the workload, performance, and training of subordinate staff; researches and analyzes bankruptcy and other files; directs surveillance activities at work sites, private homes, and businesses belonging to claimants, doctors, and/or policyholders; interviews and obtains affidavits and testimonies from relevant parties; reviews and compiles reports regarding investigations for SIFs executive management; collaborates with SIF attorneys in preparation for trials, civil litigation, and/or Workers Compensation Board hearings; testifies at trial and/or arranges for witness testimony and the introduction of evidence at trial; drafts and serves subpoenas; and administers background investigations.

            SUPERVISING INSURANCE FIELD INVESTIGATOR: under the direction of a Principal Insurance Field Investigator, plans and monitors all investigations within an assigned jurisdictional area; plans and coordinates educational seminars on fraud prevention and detection for staff; ensures that all Insurance Field Investigators have the necessary surveillance equipment and electronic devices, ensuring that equipment is maintained and in proper working order; reviews investigations in progress to determine if any revisions in scope or technique are necessary; oversees the conduct of research and intelligence gathering, ensuring that appropriate investigative procedures and steps are followed; manages record inspection and the obtainment of documentary and photographic evidence; analyzes data from various investigations to determine relationships; maintains confidential informant files and the privacy of the information gathered; obtains the services of expert witnesses; and oversees the central repository for intelligence and research gathered by subordinate investigators.

            PRINCIPAL INSURANCE FIELD INVESTIGATOR: under the direction of the Assistant Director, Insurance Fund Legal and Confidential Investigations and/or the Director, Insurance Fund Legal and Confidential Investigations, oversees and monitors all investigations Statewide; prepares operational reports of Division activity for management; develops procedures and evaluates operational goals to ensure productivity and performance; develops and maintains procedures for safeguarding confidential sources, data, and intelligence; serves as the custodian of evidence for the Division, adhering to proper procedures and rules to maintain the chain of custody for evidence obtained and secured; authorizes the use of expert witnesses and outside investigative services when necessary; and maintains and safeguards logs of criminal record checks.

MINIMUM QUALIFICATIONS

            INSURANCE FIELD INVESTIGATOR

Five years of investigative experience with law enforcement agencies; or bachelors degree and four years of insurance claims investigative experience; or bachelors degree in criminal justice; or bachelors degree and seven years of investigative experience in economic and insurance related matters.

            SENIOR INSURANCE FIELD INVESTIGATOR

Six years of investigative experience with law enforcement agencies; or bachelors degree and five years of insurance claims investigative experience; or bachelors degree in criminal justice and one year of investigative experience; or bachelors degree and eight years of investigative experience in economic and insurance related matters.

            SUPERVISING INSURANCE FIELD INVESTIGATOR

Seven years of investigative experience with law enforcement agencies; or bachelors degree and six years of insurance claims investigative experience; or bachelors degree in criminal justice and two years of investigative experience; or bachelors degree and nine years of investigative experience in economic or insurance related matters. One year of the experience must have been at the supervisory level.

            PRINCIPAL INSURANCE FIELD INVESTIGATOR

Seven years of investigative experience with law enforcement agencies, or bachelors degree and six years of insurance claims investigative experience; or bachelors degree in criminal justice and three years of experience; or bachelors degree and nine years of investigative experience in economic or insurance related matters. Two years of the experience must have been at the supervisory or managerial level.

Revised:  2/11

NOTE:  Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe.  Standards cannot and do not include all of the work that might be appropriately performed by a class.  The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written.  Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.