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Fraud Investigation Specialist II

2 months ago

Wilmington, Delaware, United States DelDOT Full time

Overview

This role is pivotal in examining intricate allegations of insurance fraud across various sectors, including property, casualty, life, and healthcare insurance. The position necessitates collaboration with the insurance sector, as well as Federal, State, and Local Law Enforcement agencies, alongside the Criminal Justice System.

Desired Qualifications

Candidates lacking the preferred qualifications may still be considered if they meet the essential job requirements.

1. A minimum of six months of experience in executing civil, criminal, and administrative investigations.

Key Responsibilities

The following duties are fundamental and represent core functions common to all roles within this classification. This list is not exhaustive, and employees may undertake similar tasks not specifically outlined here:

  • Conduct thorough investigations into alleged or potential violations or compliance concerns by identifying, obtaining, verifying, and analyzing pertinent information or evidence.
  • Gather, manage, and assess evidence, including physical, financial, background, and other relevant records and documents.
  • Develop inquiries and conduct interviews to extract information and ascertain facts from witnesses, complainants, victims, or other involved parties.
  • Interpret, clarify, and ensure adherence to applicable state and federal laws, regulations, standards, policies, and procedures.
  • Make informed judgments after reviewing all available information and recommend appropriate actions to relevant authorities, commissions, or technical supervisors, and may take enforcement actions as necessary.
  • Utilize commercial and proprietary automated information systems, software, and online resources to research, document, verify, and report on investigative and intelligence data.
  • Document all interactions, including calls, emails, inquiries, and interviews during the investigation, and may be assigned to respond to hotlines.
  • Prepare and submit detailed investigative reports that accurately document findings, supporting evidence, and actions taken.
  • Provide testimony and present evidence before boards, commissions, administrative bodies, or courts.
  • Deliver exceptional customer service to both internal and external stakeholders and the public through various communication channels.
  • Effectively communicate and engage with individuals from diverse cultures, abilities, genders, ethnicities, ages, and races.
  • May conduct surveillance, undercover investigations, and on-site inspections for assigned cases; may also make arrests or obtain search warrants related to investigations.
  • May recommend the issuance of subpoenas for information.

Job Requirements

Essential Qualifications for Investigator II

Candidates must demonstrate education, training, and/or experience in the following areas:

  • One year of experience in conducting investigations, which may include interviewing to obtain confidential information, gathering evidence, and documenting findings.
  • One year of experience in collecting, evaluating, and analyzing relevant information to make recommendations regarding alleged or probable violations of state or federal laws, regulations, and standards.
  • One year of experience in providing clear, prompt, and accurate information to address and resolve complaints.
  • Six months of experience in civil, criminal, or administrative proceedings, including providing testimony before boards, commissions, or authorities, preparing evidence or sworn statements, and managing and prioritizing cases.

Employment Conditions

Candidates must be legally authorized to work in the United States. The State of Delaware Executive Branch participates in the Federal E-Verify system, which confirms employment eligibility through the submission of Form I-9 information to the federal government.