TENTATIVE

                                                                                                           Occ. Code 6653100

New York State Department of Civil Service

Classification Standard

BRIEF DESCRIPTION OF CLASS SERIES

            Positions in this title series investigate cases of alleged insurance fraud and provide technical assistance to law enforcement agencies.  They investigate insurance fraud cases covering multiple geographic locations including those involving internal fraud by insurance company employees; organized crime; and scams involving multiple insurers.  

These positions have peace officer status and are found only in the Insurance Department. 

DISTINGUISHING CHARACTERISTICS

            INSURANCE FRAUDS INVESTIGATOR 1: entry level; investigates routine cases of alleged insurance fraud. 

INSURANCE FRAUDS INVESTIGATOR 2:  first supervisory level; serves as team leader on the more difficult and sensitive cases of alleged insurance fraud such as internal fraud by insurance company employees.

INSURANCE FRAUDS INVESTIGATOR 3:  second supervisory level; plans and monitors all investigative activities of an investigation unit. 

INSURANCE FRAUDS INVESTIGATOR 4:  regional manager; oversees all investigative activities in a region. 

INSURANCE FRAUDS INVESTIGATOR 5:  manager; oversees the Statewide planning, coordination, and monitoring of all investigative activities. 

ASSISTANT DIRECTOR, INSURANCE FRAUDS BUREAU:  exempt one position class; assists the Director of Insurance Frauds in establishing policies and directing the investigative priorities of the Insurance Frauds Bureau. 

DIRECTOR, INSURANCE FRAUDS BUREAU:  exempt one position class; directs the Insurance Frauds Bureau.

ILLUSTRATIVE DUTIES

INSURANCE FRAUDS INVESTIGATOR 1:  under the general direction of an Insurance Frauds Investigator 2 obtains evidence in the form of statements, records, exhibits, and photographs for use in court proceedings and administrative hearings; carries out undercover sting operations; develops and operates confidential and non-confidential sources of information; gathers intelligence data related to organized crime rings involved in insurance fraud; interrogates suspects and interviews witnesses; examines documents such as court records, public files, and similar records in the course of investigations; conducts interviews with lawyers, physicians, hospital administrators, insurance executives, and others; and prepares comprehensive investigative reports on findings and makes recommendations to supervisors.  

INSURANCE FRAUDS INVESTIGATOR 2:  under the general direction of an Insurance Frauds Investigator 3 coordinates the gathering, evaluation, and exchange of criminal intelligence with other employees and bureaus in the Department, and other agencies; develops strategies for handling complex undercover and surveillance cases under investigation; develops, controls, and handles confidential information for cases under investigation including confidential informant files; conducts interviews with hostile witnesses and their attorneys, lawyers, doctors, hospital administrators, and insurance executives; compiles final detailed case investigation reports; sends approved cases to appropriate agencies legal office for prosecution; coordinates the exchange of criminal intelligence internally and with various law enforcement agencies; assigns cases to Insurance Frauds Investigators 1; supervises Insurance Fraud Investigators 1 in securing, evaluating, and documenting evidence; and trains Insurance Frauds Investigators 1 in investigative techniques, insurance law, and other applicable criminal statutes. 

INSURANCE FRAUDS INVESTIGATOR 3:  under the general direction of an Insurance Frauds Investigator 4 supervises the daily activities of an investigation unit; joins in and monitors progress of sting operations; monitors all covert surveillance activities throughout an operation; manages problems that arrive during the course of investigations; reviews cases to be closed and makes recommendations on civil penalties and criminal prosecution to Insurance Frauds Investigators 4 and 5; checks that investigators have developed sufficient evidence before presenting cases to prosecution; contributes in obtaining indictments and initiating arrests; assists in preparing witnesses for court trials; and directs special insurance fraud task forces. 

INSURANCE FRAUDS INVESTIGATOR 4:  under the general direction of the Insurance Frauds Investigator 5, supervises all investigative activities in a geographic region; allocates resources and equipment based on priorities; develops guidelines for setting up and planning investigations with bureau management; develops projected timetables for cases and monitors progress on cases; provides a central repository for intelligence and research gathered by investigators during the course of an investigation; analyzes data gathered to determine if patterns exist and provides a review of various fraudulent activities; sets up the appropriate channels of communication for each investigation; creates interim reports on status of investigations for higher level staff; interacts with expert witnesses such as handwriting analysts; and supervises the use of covert identities. 

INSURANCE FRAUDS INVESTIGATOR 5:  under the general direction of the Assistant Director Insurance Frauds Bureau, manages all Statewide investigative activities and supervises Insurance Frauds Investigators 4; selects specific targets for investigations and develops strategies for carrying out investigations with the Assistant Director, Insurance Frauds Bureau; oversees the planning, coordination, and implementation of all sting operations Statewide; ensures that appropriate investigative procedures are followed; oversees Departments activities with respect to various law enforcement and other agencies; reviews all closed cases investigated by the Insurance Department and cases referred from federal, State, and local jurisdictions to determine if there has been a violation of the Penal Law; and oversees training of investigative staff. 

ASSISTANT DIRECTOR, INSURANCE FRAUDS BUREAU:  under the general direction of the Director, Insurance Frauds Bureau, oversees the planning and coordination of all bureau investigations; monitors high profile investigations; contacts prosecutorial office to discuss whether an insurance fraud case should be accepted; reviews and prepares interim and final reports on the status of investigations; reviews proposals from federal, State, and local law enforcement agencies, the insurance industry, and other sources to develop and set up undercover operations; explores the feasibility and viability as well as the operational and financial impact of proposed operations; negotiates areas of responsibilities for participants in multi-jurisdictional, multi-agency cases; forwards cases to the Office of General Counsel for administrative action and issuance of fines; and assists developing regulations and circular letters regarding the conduct of investigations.

DIRECTOR, INSURANCE FRAUDS BUREAU:  under the general direction of the Superintendent of Insurance, plans and oversees all operations including the planning, organization, procedures, and practices followed by all Insurance Frauds Investigators; establishes and implements policies; devises and approves standards and methods for the selection of cases and reviews and revises standards as conditions warrant; meets with industry officials and others to establish confidential agreements for receipt of sensitive information on suspected insurance frauds; oversees regulatory, administrative, and personnel activities for the bureau; conducts seminars for law enforcement agencies, fire departments, and related organizations to advise them of the bureaus activities and develop cooperative relationships; meets with prosecutorial officials on the status of cases referred for prosecution; and reviews, analyzes, and comments on changes in rules, laws, and regulations related to insurance fraud.  

MINIMUM QUALIFICATIONS

INSURANCE FRAUDS INVESTIGATOR 1:  six years of experience in conducting field investigations or investigations of insurance fraud preliminary to criminal litigation or prosecution.  A Bachelors Degree may substitute for two years of the required experience. 

INSURANCE FRAUDS INVESTIGATOR 2:  eight years of experience in conducting field investigations or investigations of insurance fraud preliminary to criminal litigation or prosecution, one year of which must have been in a supervisory position or acting as a team leader; or a Bachelors Degree and six years of the required experience, one year of which must have been in a supervisory position or acting as a team leader; or one year as an Insurance Frauds Investigator 1. 

INSURANCE FRAUDS INVESTIGATOR 3:  nine years of experience in conducting field investigations or investigations of insurance fraud preliminary to criminal litigation or prosecution, one year of which must have been in a supervisory position or acting as a team leader; or one year as an Insurance Frauds Investigator 2. 

INSURANCE FRAUDS INVESTIGATOR 4:  ten years of experience in conducting field investigations or investigations of insurance fraud preliminary to criminal litigation or prosecution, two years of which must have been in a supervisory position or acting as team leader; or one year as an Insurance Frauds Investigator 3. 

INSURANCE FRAUDS INVESTIGATOR 5:  one year as an Insurance Frauds Investigator 4 or two years as an Insurance Frauds Investigator 3. 

ASSISTANT DIRECTOR, INSURANCE FRAUDS BUREAU:  no minimum training and experience requirements are established for exempt positions.

DIRECTOR, INSURANCE FRAUDS BUREAU:  no minimum training and experience requirements are established for exempt positions.

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.