Insurance fraud investigator Jobs in Springfield, MA

Description

The Department of Industrial Accidents (DIA) oversees the Massachusetts workers’ compensation system.We work to ensure that those involved have the resources needed to participate by assisting injured workers, employers, insurers, attorneys, and health care providers in following Massachusetts workers’ compensation laws and regulations.The Office of Investigations is charged with ensuring all employers are in compliance with Massachusetts General Laws which require that workers’ compensation insurance be provided for all employees and the investigation of claims submitted to the Workers’ Compensation Trust Fund.

The Investigator II conducts self-initiated and assigned field checks of employers to ensure compliance with the workers’ compensation laws and issues Stop Work Orders to the employer when violations are discovered.The position also involves the investigation of claims against the Workers’ Compensation Trust Fund.All investigations are documented in report form and may require testifying at legal proceedings.

This position is based in Springfield MA.

Duties and Responsibilities (these duties are a summary and not- all inclusive):

Stop Work Orders

• Investigate assigned reported complaints of workers’ compensation violations to determine if a violation exists and issue a Stop Work Order if a violation is determined.
• Conducts self-initiated checks of employers to determine compliance with the workers’ compensation laws and take appropriate action if a violation is determined.
• Prepare accurate and thorough reports that fully document the investigation, observations and interviews.The reports are grammatically correct and completed in a timely manner within the agency’s record keeping database.
• Gathers evidence to support the issuance of a Stop Work Order which can include photographs, video and audio recordings and related documents such as building permits or business certificates.
• Assist the legal staff in case preparation and makes appropriate recommendations concerning their investigation.
• Testifies at hearings to present information and or evidence regarding violations of the workers’ compensation laws by employers.
• Informs uninsured employees of their rights under the Workers’ Compensation Act and refers them to the appropriate resources for information and further guidance.
• Makes recommendations for criminal charges to be filed against certain employers meeting agency criteria.
• Works with other state, federal and local agencies.
• Conducts fixed or mobile surveillance as needed or directed
• Posses a working knowledge and understanding of workers’ compensation laws, opinions and case law.
• Maintains a professional demeanor and composure when dealing with highly emotional subjects.Utilizes de-escalation tactics to reduce confrontations.
• Represents the DIA at community events/meetings
• Maintains CJIS certification

Trust Fund Investigations

• Reviews all submitted documents included in the filed claim
• Documents all actions in a timely, accurate and thorough manner within the agency database.
• Gathers physical evidence relating to the claim.
• Works closely with assigned DIA attorney on each case.
• Works with outside agencies relating to the claim
• Conducts internet and social media research on subjects related to claim
• Interviews all relevant parties to the claim, in person if possible
• Attends and participates in conciliations, conferences and court proceedings as needed
• Conducts physical site visits of claim locations and obtain pictures if relevant.
• Refers cases to supervisor for further action or referral, if needed.
• Is persistent in obtaining information requested relating to the claim
• Conducts surveillance relating to claim as needed or directed.
• Maintains confidentiality of all information
• Maintains professionalism at all times.

Qualifications

First consideration will be given to those applicants that apply within the first 14 days. Minimum Entrance Requirements: Applicants must have at least three years of full-time or equivalent part-time, experience in investigatory or law enforcement work. Special Requirements: Possession of a current and valid Massachusetts Class D Motor Vehicle Operator's license.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

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