Chief of Fraud Prevention

New York State Insurance Fund

Vacancy Posting A17-42

Deadline to Apply: 11/24/17

TITLE:  Chief of Fraud Prevention (Chief Investigations)

SALARY GRADE:  NS (M/C)             

DEPT/DIST OFFICE: Executive                 

WORK LOCATION: Albany or NYC

JURISDICTIONAL CLASS: EXEMPT                                                

SALARY: $ 115,000-$125,000

The New York State Insurance Fund (NYSIF) was established in 1914 as part of the original enactment of the New York Workers’ Compensation Law. The Fund’s mission is to guarantee the availability of workers' compensation insurance at the lowest possible cost to employers, while maintaining a solvent fund, as well as to provide timely and appropriate indemnity and medical payments to injured workers. NYSIF is a self-supporting insurance carrier that competes with private insurers in both the workers’ compensation and disability benefits markets in New York State.  With 160,000 policyholders, over $2 billion in annual premium and $17 billion of assets, NYSIF is the largest workers’ compensation carrier in the state and among the top ten largest workers’ compensation carriers in the nation. NYSIF provides disability benefits coverage for off-the-job injuries to more than 61,000 New York employers.

Minimum Qualifications:

Qualified candidates must possess a Bachelor’s degree and 9 years professional investigation experience in economic, risk management, data analytics or insurance related matters, 3 years of which were at a supervisory or managerial level. Preference will be given to candidates with experience investigating insurance fraud or healthcare fraud. 

Must be a resident of New York State or willing to relocate.

Illustrative Duties

Reporting directly to the Director of Confidential Investigations the Chief of Fraud Prevention will be responsible for the oversight and coordination of activities and operations of the Division of Confidential Investigations to reduce the instances of insurance fraud and abuse against the New York State Insurance Fund, and to prevent and mitigate fraud.  Duties include, but are not limited to, the following:

• Identifies methods to detect insurance fraud and abuse at the earliest moment, and mitigate the loss to the Fund.

• Works with IT data analytic staff to design data mining products that predict fraud and abuse, and combine and analyze data maintained both externally and internally to identify suspicious claims and suspicious audit results of policyholders.

• In conjunction with the Director, develops and oversees the administration of fraud training and educational programs for the Division, the Fund, policyholders, prosecutorial agencies and related organizations. The Chief ensures that Fund employees at all levels are thoroughly and effectively trained in the detection of fraud; at times, may personally conduct training sessions.

• Reviews the policy and procedures of the Fund to identify and recommend improvements that would protect the integrity of the funds paid to claimants, and the premiums charged to policyholders.

• Manages a unit within the Division of Confidential Investigations that identifies and investigates fraud committed by healthcare providers, including billing fraud and misrepresentations of claimant’s injuries. Supervises the Division’s efforts to prevent diversion of prescription drugs. Builds relationship with other law enforcement agencies to identify, investigate and assist in prosecution of healthcare fraud.

• In the absence of the Director, represents the Fund at organizations/conferences which relate to the Fund’s fraud prevention program.

• Acts as liaison with other local, state and federal high-level insurance fraud officials, as well as private sector leaders and organizations.

• Meets with high level fraud investigative and law enforcement officials to discuss topics relevant to compensation fraud prevention.

• Works in conjunction with other state and federal fraud investigative and law enforcement organizations to develop shared data resources to detect and prevent fraud.

• Administers and reviews performance evaluations, probationary reports and counseling memoranda; supervises staff in the unit, provides staff with performance and disciplinary recommendations as needed.

• Monitors potential problem areas to limit vulnerability; addresses areas of deficiency and proposes and ensures implementation of remedial action.

• Handles matters of a confidential and/or sensitive nature received from the Director of Confidential Investigations or the Executive Director, the General Attorney, or other Executive staff, as needed.

• Studies and reviews existing policies and procedures to formulate recommendations for improvement; reviews existing work and operational practices to ensure compliance with policies procedures; studies and reviews pending changes in legislation and/or regulations affecting the Fund’s practices.

• Makes presentations, as necessary, to the Executive Director and Board of Commissioners on issues related to insurance fraud and abuse prevention.

• Maintains membership in pertinent fraud investigative organizations to keep abreast of trends and potential legislation which may impact the operations of the Division.

Contact Address:  

The New York State Insurance Fund

15 Computer Drive West

Albany, NY 12205

E-Mail address: hrexec@nysif.com