This class is responsible for supervising and coordinating a Department's insurance fraud investigation operation.
Nature and Scope
A class employee reports to an administrative superior and is responsible for coordinating, planning, organizing and directing insurance fraud investigation and prevention operations. Work involves developing and implementing policies and procedures to ensure efficient and consistent application of insurance fraud investigations. Case assignments involve covert surveillance, gathering audio and video evidence to support complex investigative reports of suspected fraudulent activity. A class employee plans, assigns and monitors the work and provides final review and approval of investigative reports, and determines merit of fraud case.
Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
Develops and implements policies and procedures to ensure appropriate and uniform application of insurance fraud investigative techniques and insurance laws, rules and regulations.
Supervises directly and indirectly insurance fraud investigation activities, plans, assigns, reviews, trains and evaluates staff.
Provides final review, approval and determines merit of complex insurance fraud investigation reports.
Drafts reports and legislation consistent with national insurance fraud investigative efforts.
Disseminates information develops presentations for public awareness of insurance fraud investigations at the state and national level.
Develops and conducts insurance fraud training programs for statewide law enforcement classes.
Acts as designee in absence of the manager.
Knowledge, Skills and Abilities
The intent of the listed knowledge, skills and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.
Knowledge of laws, rules and regulations pertaining to the insurance industry.
Knowledge of management practices and staff supervision.
Knowledge of investigative procedures as it applies to criminal and civil law.
Knowledge of criminal and civil court requirements and procedures for case preparation.
Knowledge of technical and investigative report writing.
Skill in supervision: planning, assigning, reviewing, evaluating, coaching, training, recommending employment and performance related actions.
Skill in interpretation and communication of laws, rules and regulations governing the insurance industry.
Ability to assess merit of complex investigative reports of insurance fraud.
Ability to develop, implement and evaluate policies and procedures.
Ability to draft legislation and narrative reports.
JOB REQUIREMENTSfor Deputy Administrator, Insurance Fraud Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
Three years experience in planning, developing, coordinating, and implementing in-depth, long term investigations.
Three years experience in determining compliance with laws, rules, regulations, standards, policies and procedures.
Three years experience in civil, criminal or administrative proceedings.
Three years experience in providing testimony before boards, commissions, administrative bodies or court officials.
Six months experience in staff supervision which includes planning, assigning, reviewing, and evaluating the work of others.