STATE OF NEW HAMPSHIRE
HUMAN RESOURCES
CLASSIFICATION: INSURANCE
FRAUD INVESTIGATOR
Class Code: 5255-24
Date Established: 10-14-93
Occupational
Code: 3-1-9
Date of Last Revision: 12-28-01
BASIC PURPOSE: To investigate
allegations of insurance fraud and implement programs to prevent insurance
fraud and abuse.
CHARACTERISTIC
DUTIES AND RESPONSIBILITIES:
·
Investigate and
examine criminal activities in order to provide expert advice and prepare
evidence for use by prosecuting attorneys.
·
Plan and strategize
development for the investigation and prosecution of violators of New Hampshire
statutes.
·
Investigates
incidents of alleged criminal behavior by interviewing witnesses and
interrogating suspects.
·
Examines financial
records, claims and underwriting files of insurance companies to determine
potential fraud.
·
Organize and prepare
criminal cases for trial, attend court and assist trial counsel and other law
enforcement agencies.
·
Provide testimony in
court as an expert witness to summarize and give opinion on evidence and
information.
·
Collects and preserve
evidence for admissibility in court.
·
Assist Unit
Supervisor in the administration of existing laws and regulations.
·
Recommend, and assist
in drafting, new legislation and regulations or amendments to existing laws and
regulations.
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DISTINGUISHING
FACTORS:
Skill: Requires skill
in analyzing and interpreting data, policy, and procedures OR in using
equipment in order to arrive at logical conclusions or recommendations.
Knowledge: Requires
logical or scientific understanding to analyze problems of a specialized or
professional nature in a particular field.
Impact: Requires
responsibility for achieving major aspects of long-range agency objectives by
planning short- and long-term organizational goals, reviewing recommendations
for procedural changes, and developing or revising program policies. Errors at this level result in
incorrect decisions at an administrative level, and are detected subsequent to
implementation in an overall evaluation process.
Supervision: Requires
partial supervision of other employees doing work which is related or similar
to the supervisor, including assigning job duties, providing training, giving
instructions and checking work.
Working
Conditions: Requires performing regular job
functions in a controlled environment with minimal exposure to disagreeable job
elements and little risk of hazard to physical or mental health.
Physical
Demands: Requires light work, including
continuous walking or operating simple equipment for extended periods of time
as well as occasional strenuous activities such as reaching or bending.
Communication: Requires
summarizing data, preparing reports, and making recommendations based on
findings which contribute to solving problems and achieving work
objectives. This level also
requires presenting information for use by administrative-level managers in
making decisions.
Complexity: Requires
evaluating a combination of wide-ranging job functions to determine work
procedures, to solve problems, and to reach conclusions by applying analytical,
technical, or scientific thinking.
This level also requires planning policies and long-term strategies,
drawing conclusions based on available criteria, and evaluating the
effectiveness of program objectives.
Independent
Action: Requires objective assessment in
analyzing and developing new work methods and procedures subject to periodic
review and in making decisions according to established technical, professional
or administrative standards.
MINIMUM
QUALIFICATIONS:
Education: Bachelor's
degree from a recognized college or university with major study in business
administration, accounting, or economics.
Each additional year of approved formal education may be substituted for
one year of required work experience.
Experience: Five years'
experience in the insurance industry, including statistical analysis,
underwriting, claims adjudicating and accounting with specialization in the
area of property and casualty insurance.
Each additional year of approved work experience may be substituted for
one year of required formal education.
License/Certification: Possession of
a valid driver's license and/or have access to transportation for use in
statewide travel.
RECOMMENDED
WORK TRAITS: Extensive knowledge of the property and
casualty coverage, liability insurance industry, and the pertinent laws, rules
and regulations. Extensive
knowledge of statistical and financial analysis procedures. Considerable knowledge of domestic and
foreign insurance company underwriting and claim handling practices. Ability to communicate effectively to
individuals and groups. Ability to
locate individuals, collect information and conduct personal interviews. Ability to analyze widely divergent
elements of information and arrive at logical conclusions. Ability to organize thoughts and
subject matter for the use of effectively written reports. Ability to use integrity in the
protection and confidentiality of evidence and sensitive documents and files. Ability to develop comprehensive and
conclusive investigatory case reports of a complex nature. Ability to establish and maintain
effective working relationships with employers, federal, state and local
government and industrial officials and the general public. Must be willing to maintain appearance
appropriate to assigned duties and responsibilities as determined by the agency
appointing authority.
DISCLAIMER
STATEMENT: This class specification is descriptive
of general duties and is not intended to list every specific function of this
class title.
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Last Updated 01/07/03
URL: http://www.nh.gov/hr/classspec_i/5255.htm